Qass 
Book 



GFNERAL BOARD OF HEALTH. 



SECOND REPORT 

ON 

QUARANTINE. 



YELLOW FEVER. 



TO THE QUEEN'S MOST EXCELLENT MAJESTY. 

May it please your Majesty, 

Although the circumstances which first called 
our attention to the operation of the present system of 
Q'.iarantine, led us to restrict our Report chiefly to the 
statement of evidence proving the inefficacy of Quaran- 
tine in averting the outbreak and checking the progress 
of Epidemic Cholera, yet we had received a considerable 
'jody of evidence showing the failure of Quarantine as a 
iieans^ of prevention in other pestilential diseases. Since 
that time we have received from foreign consuls throui>h 
Your Majesty's Principal Secretary of State for Foreign 
Affairs, and from eminent medical officers and others, who 
have enjoyed peculiar opportunities of observation, a large 
amount of additional evidence ; and as this further evi- 
dence appears to us to display the conditions on which 
the spread of epidemic diseases in general depend, as well 
as the inipolicy of the Quarantine laAvs which are still in 
force in this and other countries, we deem it our duty, 
humbly to pi'esent to Your Majesty, a summary of the 
results of our more recent inquiries, which we now do in 
this our Second Report as follows : — 

We represented in our First Report, that Quarantine 
is based on two assumptions ; first, that epidemic 
diseases depend on a specific contagion, and secondlj^, 
that by the prevention of communication with infected 



Importation of Epidemic Disease Hypothetical, 



persons and articles, it is practicable to prevent the 
introduction of epidemic diseases into uninfected com- 
munities. 

W e apprehend the question of contagion has no neces- 
sary connexion with that of the importation of epidemic 
disease. The alleged importation of epidemic disease is 
a question of fact to be determined like any other fact by 
evidence. The evidence about to be adduced appears to 
us to be decisive against the allegation of importation, 
not because it is decisive against the hypothesis of conta- 
gion, but because it shows the utter insufficiency of the 
grounds laid to establish the fact of importation. In like 
manner with respect to Quarantine, if it were admitted 
that one true and invariable character of epidemic diseases 
is, that they are contagious, it would not follow that Qua- 
rantine can prevent or even check their spread. Whether 
Quarantine is capable of exercising any such influence or 
not, is a question to be determined like other questions of 
fact by observation and experience ; and as we endea- 
voured to show in our former Report, the real practical 
question for the public and the legislature, is not whether 
epidemic diseases are contagious, but whether Quarantine 
can prevent their introduction and extension. 

With respect to Epidemic Cholera, we have shown in 
our First Report by a body of evidence which has not 
been impugned, and which is generally admitted to be 
conclusive, that whether this disease be contagious or not, 
Quarantine has had no influence whatever in checking 
its progress, and that wherever, in the recent course of this 
pestilence throughout Europe, Quarantine was put in 
force as a measure of prevention, it was speedily aban- 
doned as useless and even mischievous. 

On tlie first irruption of this pestilence into Europe in 
1831-2, every nation successively menaced by it, endea- 
voured to bar it from passing its frontier, by rigorous 
Quarantine, and by military cordons, but in every instance 
Avithout avail. Again the like attempt was made in 
1847-8, and again it was everywhere admitted to be utterly 
ineffectual. Though many medical men in Great Britain 
had long ceased to place confidence in these expedients, 
yet the constituted medical authorities appeared still to 



V ^^(^onseqiient pj^actical inutility of Quarantine, 3 

regard them in some degree as securities ; but founded 
on recent experience, the Royal College of Physicians of 
London have changed their former belief, have declared 
an opinion in accordance with that previously expressed 
bv the General Board of Health, and have recorded their 
conclusion in the following words : — 

Cholera appears to have been very mrely communicated by 
personal intercourse, and all attempts to stay its progress by 
Cordons or Quarantine have failed. From these circumstances, 
the Committee, without expressing any ]30sitive opinion with 
respect to its contagious or non-contagious nature, agree in 
drawing this practical conclusion^ that in a district where 
Cholera prevails, no appreciable increase of danger is incurred 
by ministering to persons affected with it, and no safety afforded 
to the community by the isolation of the sick." 

From the atmospheric or climatic changes which have 
hi every country generally preceded an outbreak of 
Epidemic Cholera, — from the extent of its range traversing 
the globe in zones, — from the steadiness and in many 
instances the post-like regularity, of its course, — from the 
number and distance of the points of its simultaneous 
outbreaks, — and from the wide spread infection of popu-^ 
lations with symptoms indicating its actual presence and 
operation many days, and in some instances weeks, before 
it assumed its proper and developed shape, — it appeared in 
the highest degree improbable that a Quarantine vessel 
placed at the entrance of a seaport, or a line of soldiers 
guarding the frontier of a country, should exert any real 
influence in staying the progress of this pestilence; and 
recent experience has rendered the fallacy of this expecta- 
tion so palpable, that the attempt to avert the visitation of 
Epidemic Cholera by such an agency has been not unaptly 
compared, to that of the countryman " who endeavoured 

to pound out the crows, by shutting the park gates." 

Were there, then, no other epidemic diseases against 
which Quarantine is supposed to be a protection, we 
might justly consider that recent experience has established 
the fact of its uselessness : but as it appears to be still 
the opinion of some persons that the public safety requires 
the intervention of Quarantine, particularly against 
Yellow Fever and Plague, we now proceed to state such 
information as has been submitted to us, respecting the 

B 2 



4 Opinions regarding the Nosological Character of Yellow Fever. 



practical value of Quarantine as a security against the 
first of these two diseases. 

With respect to Yellow Fever, medical authorities 
are divided as to whether this disease is essentially dif- 
ferent from the ordinary fever of the countries in which 
it is prevalent, or whether it is the same disease differing 
only in intensity ; hut the weight of authority appears 
to be in favour of the latter opinion. The College 
of Physicians of London have recently pronounced a 
decided opinion in accordance with this view, in the 
following terms :• — 

^' After a very careful consideration of all the facts and argu- 
ments adduced on both sides, the College are of opinion that 
sufficient grounds have not been laid for stating that Yellow Fever 
is a disease sui generis." 

From the descriptions of the most careful and experi- 
enced observers, it appears that fever, within the Yellow 
Fever zone, prevails under three forms more or less 
distinct — the Intermittent, the Remittent, and the Con- 
tinued. The Intermittent, of course, prevails chiefly in 
marshy and swampy districts ; the Remittent, which is 
the ordinary endemic, or acclimating fever of the country, 
also prevails chiefly, but by no means exclusively, in 
similar localities ; the Continued, in like manner, some- 
times prevails in marshy and swampy districts, and then 
seems to be based on ague ; but at other times it prevails 
where there is no marshy ground, presents no manifest 
character of ague, and approximates to the Continued 
type of colder climates. It is to this more continued 
form of the disease, whether prevailing on marshy 
ground, or otherwise, that the name of Yellow Fever is 
commonly given. But the highest authorities are agreed 
that these varieties do not constitute distinct and essen- 
tially different diseases. 

We observe, indeed, that the medical men, who have 
had opportunities of j)ersonally witnessing this disease on 
the largest scale, and under the greatest variety of cir- 
cumstances, have, with scarcely an exception, arrived at 
the conclusion, that Intermittent, Remittent, and Yellow 
Fever are modifications of the same disease influenced by 



Mortality among British Troojjs in the West Indies. 



5 



peculiar conditions. Were it, however, universally ad- 
mitted, that Yellow Fever is, on the contrary, a disease 
sui generis, this would afford no reason whatever for its 
being on that account peculiarly amenable to quarantine. 

Though fortunately the inhabitants of Great Britain 
are not within the range of a Yellow Fever epidemic, yet 
the subject of Yellow Fever is one which deeply con- 
cerns the British people. This pestilence is the great 
and constant scourge of the British army and navy, 
within the yellow fever region and near its limits ; though 
its ravages in the army are probably less upon the 
w^hole than among colonists in general. From the 
statistical reports of the British army for the twenty 
years, from 1817 to 1836, it appears that in Jamaica 
with an average annual strength of 2,578 men, the 
average number of deaths annually from all causes was 
813, and from all fevers 263; and of this number the 
deaths returned under the designation of Intermittent, 
Remittent, and Yellow Fever amounted to 258 ; that is, 
during a period of twenty years, all the troops in Jamaica 
that died of fever, with the exception of an annual average 
of five cases, died under one or other of these forms of this 
disease. So in the Windward and Leeward Islands, with 
an average annual strength of 4,333 men, the average 
deaths annually from all causes being 340, and from all 
fevers 160, the deaths from one or otiier of the above- 
mentioned forms of fever were 123. But in the Gambia 
during 19 months, the only period in which white troops 
were stationed there, out of a strength of 420 men, 
there perished from all causes 279 ; and out of this 
number 234, or about nine- tenths, were destroyed by 
this disease. Taking the experience of twenty years it 
appears that the average annual mortality from Jnter^ 
mittent. Remittent, and Yellow Fever alone in the West 
Indies and Vr'estern Africa, among a body of men at 
the age of least mortality, and selected with especial 
reference to their physical strength (each recruit having 
to undergo strict medical examination before being ad- 
mitted as eligible for the service), is more than three times 
as great as the average annual mortality from all causes 
among the mixed population of sick and healthy, old and 



'Principal Observers of Yellow Fever. 



young, in our own country ; while at the Gambia during 
19 months, the mortality from this disease appears on a 
similar comparison to have been seventeen times as great. 

The opinion entertained of the origin, mode of pro- 
pagation and localizing conditions of this pestilence, 
must necessarily influence the measures recommended for 
the security of the men exposed to this extreme danger. 
The facts we are about to present have, therefore, a highly 
important bearing on the means of protecting troops in all 
British colonies subject to the visitation of Yellow Fever, 
as well as on the general question of Quarantine. 

Within the last forty years Yellow Fever has been 
the subject of careful and extended observation. Medical 
practitioners resident within the limits of the Yellow Fever 
region, medical officers of the British army and navy who 
have witnessed formidable outbreaks of the epidemic in 
the places in which they have been stationed, and foreign 
physicians, some of whom have made it the great object 
of their professional life to acquire a knowledge of this 
pestilence by studying it in the countries in which it is 
prevalent, have given full accounts of the results of their 
investigations. Among these inquirers the first place 
must be assigned to a French physician. Dr. Chervin, who, 
with a devotion rarely equalled, passed eight years in the 
countries ravaged by this pestilence, with the sole view of 
studying it in its true and proper seats. In the prosecution 
of this object he travelled through all the colonies of 
France, England, Spain, Holland, Denmark and Sweden, 
together with every part of North America in which the 
disease is known, having in this pursuit traversed over and 
made investigations in 37 degrees of latitude. 

Another distinguished investigator, a countryman of 
our own, Dr. William Fergusson, who resided upwards of 
twenty years in the Yellow Fever region, and as principal 
medical officer in the Leeward Islands had the most ex- 
tensive opportunities of observing the true character of 
this disease, has left a highly valuable record of the results 
of his long official experience. 

Two of our medical inspectors. Dr. Milroy and Dr. 
Gavin, during their late mission to the West Indies to 
aid in arresting the progress of epidemic cholera, have 



Reports and Evidence contained in Appendices. 



7 



collected, from their own personal inquiries, valuable 
information respecting Yellow Fever. Dr. Gavin has 
recently been an eye-witness of a severe outbreak of the 
disease in its epidemic form. 

We are indebted to Dr. Gillkrest, Inspector-General 
of Army Hospitals, for a valuable monograph on one of 
the most carefully observed outbreaks of Yellow Fever on 
record, namely, the Yellow Fever epidemic at Gibraltar, 
in 1828. An abstract of this important paper recently 
presented to the Academy of Medicine of France, has 
called forth the high approbation of that body, and we have 
given the original document at length (Appendix No. I.,) 
as being not only an account of this particular epidemic 
by an eye-witness, in which the main events are ably 
analysed and succinctly described, but as recording the 
general experience of a long professional life devoted to 
the study and history of this particular disease. 

We also subjoin (Appendix No. II.) the Official reply 
of T. Jones Howell, Esq. Judge Advocate, and Judge 
of the Vice- Admiralty Court of Gibraltar, to Secretary 
Sir George Murray, respecting the origin of the Yellow 
Fever epidemic of 1828, in that garrison; this paper 
being a close and judicial examination of the nature and 
value of the evidence presented to the Commission. 

We further append " Remarks on West Indian Fever,'* 
by Dr. A. Browne, (Appendix No. III.,) presenting 
a summary of facts and observations with reference to 
fever in the West Indies, and coast of Africa, " contained 
in the statistical Reports for the Army from 1817 to 
1836, and for the Navy from 1837 to 1843." 

And lastly, we subjoin (Appendix No. IV.) a Notice of 
the proceedin^^js of a JBoard of Inquiry held at the office of 
the Army Medical Department (1849-50), on the subject 
of Yellow Fever, with a Report by Dr. Burrell, presented 
to the Lords of the Council, and containing the reasons 
for the opinions delivered by him on that occasion. 

In treating this subject in its practical rather than in 
its scientific aspect, it is necessary to advert to certain 
similarities, as well as to certain differences, which distin- 
guish Yellow Fever, as an epidemic, from Cholera, which 
was the special subject of our former Report. 



8 Yellow Fever chiefly confined to Tropical Regioiis. 



From the information derived from the sources above 
mentioned, as well as from others, it appears that 
Yellow Fever differs from Cholera as an epidemic in 
two important circumstances : first, in being limited to 
a certain zone, and secondly, in attacking chiefly those 
who have recently arrived within that zone, or near 
its limits. While Cholera spreads from continent to con- 
tinent, ravaging the nations of all climates, unchecked by 
elevation of temperature, and often prevailing in intense 
cold — the seats of YellowFever are strictly confined to those 
parts of the tropical or equatorial regions, in which there 
prevails for several weeks in succession a steadily con- 
tinued but not extremely elevated temperature ; that is, 
where the thermometer ranges from 76° to 86° of Fah- 
renheit, and varies not more than from five to ten degrees 
night and day. Hence the West Indies, portions of 
North and South America, the coast of Africa, and the 
south of Spain are its principal seats, and it is stated to 
have appeared at Lisbon (1728), and in Leghorn (1804). 
Cases of it are said to have been observed in India on 
more than one occasion, but there is no record of its ever 
having prevailed there as an epidemic ; it is generally 
conceived that extreme heat and drought are unfavour- 
able to its development ; and it appears to be incapable of 
existing in a cold country, or even in the very heart of 
its own region during the prevalence of a cold wind. 

" Yellow Fever," says Dr. Drake, " which has repeatedly 
prevailed in almost every town up the Mississippi to Vicksburg, 
NX. 32^ 24'^ has never but once reached Meaiphis in 35°, and 
has not prevailed at any intervening town. Thus its limits, on 
the whole, have been those of the live oak, cypress, and long moss ; 
and it will not, any more than they, be found among apple 
orchards, wheat fields, and groves of blue ash, sugar maple, and 
the arborescent buckeyes." 

The other characteristic distinction between Epidemic 
Cholera and Yellow Fever is, that while Cholera acknow- 
ledges no acclimatization, attacking equally natives and 
new comers ; the acclimated Creoles, natives of the Yellow 
Fever zone, escape the disease nearly altogether. The 
whole history of Yellow Fever shows that its most suscep- 



Peculiar susceptibility of Persons newly arrived. 9 



tible subjects are those who have recently arrived within 
its sphere, particularly the inhabitants of northern cli- 
mates, and that the predisposition to an attack, increases 
with the degree of the northern latitude from which the 
stranger has arrived, and the shortness of the interval that 
has passed since he left the European for the Equatorial 
region. 

In illustration of the comparative security of native 
inhabitants over new comers, Dr. Fergusson adverts to 
the experience of the troops at Ca})e St. Nicholas Mole, 
St. Domingo, among whom soon after disembarking, 
Yellow Fever broke out at every station and in every 
place." At the commencement of the epidemic a census 
w^as taken of the inhabitants of the town exclusive of the 
negro slaves ; they were found to be very nearly equal in 
numbers with the newly arrived white soldiers. At the 
conclusion of the epidemic when 1,500 soldiers, the ori- 
ginal complement of the men, had perished, the inha- 
bitants had lost not more than one in thirty of all ages. 

Dr. Burrell states that : — 

" Of thirty regiments that arrived in the Windward and 
Leeward Islands between 1816 and 1848, ten were attacked 
with black vomit fever a very short time after landing; two 
within three months ; eleven within twelve months ; five within 
two years ; and two within three years of their arrival. Of 
thirteen regiments which landed in Jamaica between the years 
1816 and 1834, four were attacked within six months; seven 
within twelve months ; and two within eighteen months. From 
1838 to 1848, seven regiments arrived in that island, but the 
emancipation of the negroes permitting the troops to be quar- 
tered in the mountains, a few cases only of black vomit fever 
appeared, within that period, in two of them soon after 
landing." 

The practical conclusion drawn by the most eminent 
medical authorities conversant with this disease, from 
these its peculiar characteristics is, that it is as impossible 
for Quarantine to alford protection against Yellow Fever, 
as it is for it to afford protection against Cholera. The 
fact and the inference are thus stated by Dr. Fergusson. 

" A body of English troops arrives in a West India colony, 
and soon after the Yellow Fever breaks out amongst them. 
The seasoned Creolised white inhabitants feel little or nothing 



10 



Resemblance to Cholera in affection of the Blood. 



of it, and the coloured classes without exception, the most nu- 
merous by at least 10 to 1 of the inhabitants, with whom all 
strangers are ever in necessary communication, stand by abso- 
lutel}^ untouched. How is this? Import Small-pox, or any 
truly contagious disease, and they will suffer far beyond the 
usual sufferings of Europeans. Take them to England, they 
will be as liable as ourselves to fall under the dominion of 
Typhus Fever ; to the Levant, under that of the Plague. Of 
Psora (itch) and Syphilis and every other infection, they will 
have their full shares. Yellow Fever alone they cannot take, 
and how is this to be explained, but upon the obvious fact of 
that disease being a seasoning fever of malignant type peculiar 
in a great degree to newly arrived Europeans, the product of 
high temperature and unwholesome locality. 

" In these our latitudes, ' cold and fatigue, and sorrow and 
hunger,' under circumstances of accumulation, will generate 
fever everywhere ; but every region, every climate, will exhibit 
its own form of fever. With us it is Typhus ; in the warmer 
countries of Europe, Remittent ; in the upper Mediterranean, 
Plague; in the Antilles and Westeni Africa, Yellow Fever ; 
this last being restricted to particular localities, temperatures, 
and elevations. While Typhus Fever goes out when you enter 
the tropics, it is there that Yellow Fever commences ; the pure 
epidemic of a hot climate that cannot be transported or com- 
municated upon any other ground. Places, not persons, con- 
stitute the rule of its existence. Places, not persons, compre- 
hend the whole history, the etiology of the disease. Places^ 
not persons ! Let the emphatic words be dinned into the ears 
of the Lords of the Treasury, of Trade and Plantations, until 
they acquire the force of a creed, which will save them here- 
after from the absurdity of enforcing a Quarantine in England 
against an amount of solar heat, of which its climate is insus- 
ceptible. Let them further be repeated in the Schools of Me- 
dicine, until the Professors become ashamed of imbueing the 
minds of the young with prejudice and false belief, which, 
should they ever visit warmer climates, may cause them to be 
eminently mischievous in vexing the commerce, and deeply and 
injuriously agitating the public mind of whatever community 
may have received them." 

It may be interesting here to state, that Avhile Y'ellow 
Fever thus differs from Cholera in circumstances which 
greatly influence the extent of its range, all observers are 
agreed that there are two conditions of the system in 
which there is a rem.arkable resemblance between the two 
diseases. The first of these relates to the condition of the 
blood. It is the general opinion that in Cholera a pecu- 



Intellect usually unimpaired, as in Cholera. 11 



liar poison enters the blood, in consequence of which this 
vital fluid becomes disorganized and a fatal discharge 
takes place of watery fluids derived from it. In Yellow 
Fever, the blood appears to be equally poisoned and dis- 
organized, but in this disease it is the more solid portions, 
and particularly the red particles, that are poured out 
from the system. 

In Yellow Fever," says Dr. Fergusson, " the crasis of the 
blood is as much broken down before death, and its vitality 
destroyed, as it could be b}^ the introduction of the poison of 
the serpent's tooth ; we may truly say^ it is killed by the poison, 
and in the language of John Hunter, that ' fatal Yellow Fever 
is the death of the blood ;' it wells up in floods from the mu- 
cous surface of the stomach, in the form of black vomit ; it 
escapes from the gums, the nostrils, the eyes, the ears, even the 
skin itselfs in any or every part, and after death it will be seen 
to have lost all the character and composition of blood, being- 
found in its vessels like the lees of port wine, or the grounds 
of coffee." 

Dr. Gavin states, that cases occur during the Yellow 
Fever epidemic now prevailing in Demerara, some of 
which have come under his own observation, in which 
the symptoms simulate those of Cholera so closely that, 
in a Cholera epidemic, they would be called Cholera.* 

The second point of resemblance between Yellow Fever 
and Cholera is the similar condition of the brain. In 
Cholera the clearness of the intellect, and the calmness 
of the mind up to the last moment of life present a striking 
contrast to the mental dulness and cloudiness, the deli- 
rium and ultimately the total unconsciousness of Typhus : 
the functions of the brain in Yellow Fever are generally re- 
tained in the same perfect manner as they are in Cholera. 

" Self possession and courage,"says Dr. Fergusson," ordinarily 
characterise the disease. I have seldom known any one who 
could not give clear directions in regard to the disposal of their 
affairs, or fail to conduct themselves with resignation. It is not 
always, nor often, a painful disease in its termination, and the 
vomitings are never, I may say, attended with pain. A gallant 
officer said to me, ' You see I am posting to the other world, 
and you cannot prevent it, but I am as easy as if I was in a 
post chaise.' Sir James Leith, Governor- General of the 
Windward and Leeward Colonies, whose chivalrous heroic 

* See Appendices pp. 145, 298, for exceptional varieties in other epidemics. 



12 



Determining Causes often apparently trivial. 



character graced and adorned the military profession, when he 
contemplated that harbinger of death, the black vomit, pouring 
from his stomach, on the evening preceding his death, rose from 
his couch in full possession of all his acumen, to execute some 
legal deeds of importance, declaring at the same time, in reply 
to my dissuasions, he could with equal facility have drawn out 
a plan for military operations. Lieutenant Wright, one of my 
earliest patients at Port-au-Prince, St. Domingo, on the fourth 
day of the fever rose from his bed in perfect possession of his 
senses, dressed himself correctly, and went into the market- 
place accompanied by myself, where he spent some time pur- 
chasing fruits and other things, returned to his barrack -room, 
where he shortly expired in a torrent of black vomit. Lieutenant 
Mackay, of the Quarter-Master-General's department. Cape 
St. Nicholas Mole, on the day of his death, was up and dressed 
on the sofa, with books and papers before him at ten in the 
morning, passing jokes of comparison between his own dingy- 
complexion, made so by the disease, and that of his mulatto 
nurse ; at two he expired in the same way as Lieutenant 
Wright. A sailor on board the flag-ship of Admiral Harvey, 
with whom I was taking a cruise for my health in the year 
1816, w^as attacked with Yellow Fever, but he v/ould not ac- 
knowledge he was ill. He was all the time up and dressed one 
of the earliest in the morning, saying that there was nothing 
the matter with him, and that he would go back to his duty the 
next day. He owned he was sick at stomach, and that the 
vomitings were dark-coloured, but that was from the red wine 
negus they had given him to drink, or the coffee which the cook 
had spoiled, and therefore made him sick ; and in this persuasion 
instead of going to his duty, he died on the following day. 
Similar cases are given by Dr. Rush in his inquiries into the 
Yellow Fever at Philadelphia." 

"The patient," says Dr. Blair, "dies with intelligence un- 
clouded, and his muscular strength but little impaired, telling 
you he is getting quite well, or as a poor dying Irish sailor ex- 
pressed himself, ' iligant this morniu.' 

" Often," says Dr. Davy, " extreme danger exists when the patient 
considerr-;, himself all but well, and when the pulse is little dif- 
ferent from that in health." 

Yellow Fever further resembles Cholera in the slight- 
ness of the apparently determining cause which, often 
ushers in a fatal attack. 

Sometimes," says Dr. Blair, " the determining cause seemed 
of the slightest description : the shock on the stomach by an 
ice-cream or glass of iced punch, or the indigestion of an unripe 
orange, would occasional! v set the train of symptoms in motion. 



Injurious influences of Fear, Mental Anxiety^ Sfc. 13 



It seemed at one time as if those resident in the infected districts 
circulated the poison habitually through their system; that old 
residents had in an eminent degree ths power of eliminating it and 
keeping its presence latent — had a tolerance of it; but that 
new comers, and particularly those of florid complexion and rigid 
fibre, were constantly, in reference to the presence of the virus, in 
a state of tottering equilibrium ; so that in them the slightest un- 
favourable impulse to the balance — the lowering of the vital powers 
by fatigue, the suppression of any of the depurating secretions, a 
shock to either of the nervous centres, or the depressing emotions — 
were sufficient to excite the latent poison. ******* 
In those cases where the immediate attack was referable to 
a slight determining cause, the disease always exhibited its 
utmost violence. An instance of the determinincj effects of the 
depressing emotions is well exhibited in the case of Mr. Rankin, 
an old colonist. Mr. R. had been in good circumstances up 
to a short period before his death, in 1842, and although living 
in the midst of the worst district of Water-street, he retained 
robust and uninterrupted health. About 1842 he became in- 
volved in the general mercantile distress then prevalent in 
George Town, in fact, he was utterly ruined. Moreover, im- 
mediately before his illness^ he became particularly depressed 
by w'hat he supposed to be treachery on the part of one of his 
friends. The malaria then produced its deadly results on liim. 
He died of black vomit, after having passed unscathed through 
the pestilence of the previous years. Even fretting and temporary 
chagrin have been the determining cause of a fatal invasion ; an 
instance, the Notes of which are now before me, is in the case 
of Dr. Leitch, late Suro^eon to the ' Arabian ' emio-rant trans- 
port. On Saturday morning, the 22nd September, 1843, the 
proyjrietor of a plantation on Wakenam engaged to call for Dr. 
Leitch, to carry him for a few days to his estate. The gentleman 
neither came at 11 o'clock, the hour appointed, nor sent anv 
message of explanation. Dr. Leitch. all prepared, waited hour 
after hour on the quarter-deck (under awning) till evening, and 
was much fretted by the disappointment. That night he got the 
Yellow Fever, and died on the sixth day of his illness, with black 
Yornit. In the same page of my Notes with Dr. Leitch, I find a 
case of death from Yellow Fever, the determining cause of which 
also was distress of mind. It was a mulatto, of the name of Felix 
Theome, a native of Martinique, whose goods had been distrained 
in Berbice, by a Commissary of Taxation, on I he plea of tlieir 
being smuggled. As was to be expected in a constitution of the 
tropical regions, his system struorgled hard against the strong 
teudeiicy to death. He died on the 12th day of his illness, and 
four days after black vomit had ceased. 

" The mental emotions had not only the effect of developing 
the disease in the susceptible, and those who had been exposed to 



14 Outbreaks of Yellow Fever not traceable to d Foreign Origin, 

the morbific localities, but also played an important part in the 
procession of the symptoms^ and on the result. During the pro- 
t^ress of the epidemic it was discovered that if a sailor, affected 
with fever, happened to be brought to the hospital when the hearse 
was present, the worst prognosis was to be formed. The intelli- 
gence of the arrival of the hearse had also the most injurious effect 
on the sick and convalescent within the wards. So much was this 
the case that a new dead-house had to be built out of sight of the 
hospital, and the approach of the hearse so managed that its visits 
were unknown to the patients. As fear and grief and the other 
depressing congestive emotions acted a,s auxiliary causes, so, on 
the other hand, did confidence and hope obviate the tendency to 
death ; and, in accordance^ moral courage and exaltation of feeling 
acted as the most powerful adjuvans of treatment." 

Yellow Fever, like Cholera, breaks out where there is 
not the slightest ground for supposing that it is derived 
from a foreign origin, where the strictest inquiry fails to 
trace it to an infected source, and often where communica- 
tion with infected persons or articles is impossible. Take 
for example one of the most recent instances ; the out- 
break of Yellow Fever in Brazil in the autumn of 1849, a 
country in which it is supposed rarely to have occurred ; 
and yet, if the disease he capable of importation as an 
epidemic, it must have been constantly carried from the 
West Coast of Africa to Brazil by the numerous cargoes 
of slaves which, it is notorious, were smuggled into the 
latter country, closely packed together in slave ships, 
under circumstances most favourable for preserving the 
virus of a contagious disease. It is stated by masters of 
ships that, during the prevalence of the late epidemic, 
1 though they came direct from Europe and held commu- 
\ nication with no vessel of any kind on their passage, 
j Yellow Fever made its appearance on board their ships 
as soon as they approached the coast of Brazil, and came 
within the influence of the land breezes. Here communi- 
cation with infected persons or articles was impossible, 
just as in the Epidemic Cholera of 1848, communication 
between the first persons attacked in London was proved 
to have been impossible. See Report on Epidemic Cho- 
lera, pp. 14, 23. 

Dr. Gavin states, that when Yellow Fever broke out 
in George Town, Demerara, at the end of 1851, cases 
of the disease had occurred in the town before any ap- 



spread of Yellow Fever lohere communication impossible, 15 



pearance of it among tlie shipping ; and he records the 
fact that 

Some seamen arriving from Europe were attacked with Yel- 
low Fever on nearing the coast and getting into the muddy water 
some days before their arrival in harbour, and who had had no 
communication with aught else but the skies and seas and their 
own vessel." 

In like manner Dr. Gillkrest states that in the Yellow 
Fever epidemic of Gibraltar great numbers of soldiers 
were attacked who had never come, and who could not 
possibly have come in contact with an infected individual; 
that the men had no opportunity of mixing with the civil 
population or entering houses which might have contained 
sick persons ; being during more than three months of the 
period encamped outside the walls without being allowed 
to enter the town, except when on duty. 

" The mass of those attacked," he says, "merely marched to 
their guard-houses, to which, certainly, the inhabitants were 
not in the habit of resorting, and where the soldiers, as cer- 
tainly, came in contact with no persons suffering from Yellow 
Fever. Arrived at his post, a soldier was placed as sentry, not 
in the midst of a dense population ; not wdth people about him, 
from whom disease might be transmitted ; nothing of this 
occurred. The guard in charge of the ruins of Pompeii is not 
in the midst of a deeper solitude, than were often the soldiers 
at Gibraltar, as they inhaled the ' death-blast,' in districts 
abandoned by the inhabitants. The men were far removed 
from contact with sick people — far out of hearing, far out oF 
sight." 

Mr. Amiel, surgeon of the 12th regiment, confirms 
this testimony. 

" r may add," he says, ''that when so many new cases occurred 
in the regiment after it had resumed the town duties^ the men 
composing the guards were marched directly from the Neutral 
Ground to the Guard-houses, mostl}^ by the Line-wall, and avoid- 
ing the streets as far as possible ; those in guard-houses had no 
communication whatever with any description of inhabitants, and 
still less with the sick, or articles belonging to them ; they were 
marched to and from the posts of the guards without beino- 
allowed any improper intercourse, and ultimately they went back 
to the Neutral Ground, with the same precautions, and in the 
same orderly manner as they had come from it; th\is rendering it 
impossible to trace, to any contagious sources, the malady which 



16 Simultaneous appearance of Cases in different Localities. 



unexpectedly manifested itself in many of them but a few days 
after they had been employed on that duty." 

Mr. Amiel also cites, as an example of the sponta- 
neous and local origin of tlie disease, its occurrence at 
Medina Sidonia, in 1801, a town thirty miles distant 
from the coast, at a time when every place in the neigh- 
bourhood enjoyed a perfect state of health. In this case 
it was impossible to refer the outbreak of the disease to 
any foreign source ; yet it gradually proceeded in the 
same manner as the epidemic in Gibraltar. 

Yellow Fever, like Cholera, breaks out simultaneously 
in different and distant towns, and in different and distant 
parts of the same town, among persons who have had no 
communication with the sick. For instance, recently, on 
its appearance in Rio de Janeiro the disease after lingering 
a few days in one particular street, being confined to two 
or three houses in that street, suddenly broke out at 
exactly the opposite end of the city, a mile and a half 
from the street in which the first five or six cases occurred. 
There is no evidence that there was any communication 
between the persons infected in the first locality, and 
those suddenly attacked in the second, as we know there 
was no communication between the twenty-nine persons 
first attacked with Cholera in London in 1848. 

Dr. Hennen, the Principal Medical Officer and In- 
spector of Health at Gibraltar, says : — 

" I have not been able, in any instance, to trace the progress of 
the disease to a single point; neither did I observe any sub- 
sequent attack in the company or regiment that had any apparent 
connection with the case of the sergeant whom I mentioned to 
have been the first sufferer." 

Dr. Smith, surgeon of the 23rd regiment, says : — 

''The rise of our epidemics has not been traced from a known 
focus of contagion to one or more individuals : instead of creeping 
from one family to another, cases have frequently appeared 
unconnected and scattered at different points, spreading, in some 
instances, with the rapidity of the electric fluid, and attacking 
persons who had never approached the sick, nor any assignable 
source of contagion." 

Dr. Gardiner, surgeon to the Naval Hospital, and 



Epidemics generally preceded by Sporadic Cases. 17 



member of the Board of Health established in the 
garrison, in 1813, says: — 

" The disease did not spread from any focus, but broke out in 
fifty different places at once." 

Other instances of the simultaneous outbreak of Yellow 
Fever, in different and distant localities without com- 
munication, might be multiplied indefinitely. 

In Yellow Fever epidemics as in those of Cholera there 
appears to be a gradual local development of the disease, 
the outbreak of the epidemic being preceded by individual 
or sporadic cases, in greater or less number. 

The medical officers resident in Gibraltar concur in 
stating that individual cases, identical with those of the 
epidemic of 1828, had been observed by them every year, 
from 1816, up to the breaking out of the epidemic. 
Before the commission appointed to inquire into the 
origin of this epidemic, Messrs. Fraser and Wilson, 
medical officers attached to the Civil Hospital, and both 
having extensive private practice, depose to their having 
annually witnessed cases of fever identical with the 
epidemic. 

Mr. Wilson declares that he treated about 200 cases 
of the late epidemic : that he had seen the same disease 
in Jamaica^ in Carthagena, and in the Flavannah, and 
that he had in the Civil Hospital at Gibraltar generally 
every year, from 1815 to 1828, when that epidemic 
broke out, met with cases of the same disease accompanied 
by the same symptoms, and terminating in death under 
the same circumstances as cases of the late epidemic. 
He adds that he had carried from tlie West Indies to 
England a specimen of the black vomit, and speaks 
positively to the identity with it of the black vomit 
which he had observed in sporadic cases at Gibraltar 
between 1815 and 1828. 

Mr. Fraser stated that he had treated about 200 cases 
of the late epidemic, and that he had seen many, perhaps 
500 or 600 more ; that he had been surgeon to the Civil 
Hospital about five years, which situation necessarily 
forced him to pay attention to the general health of the 
place, and that he had directed his attention particularly 
to the subject of fever ; that during the five years of his 

c 



18 



Sporadic Cases in the Civil Hospital, Gibraltar^ 



residence, and previous to August 1828, he saw between 
40 and 50 cases which he is inclined to identify with the 
epidemic; that he saw no difference in symptoms 
between these sporadic and the epidemic cases, even 
those with the black vomit ; and that an analysis of the 
black vomit had been made in the Civil Hospital long 
before the breaking out of the epidemic. 

" It was evideiit," says Dr. Smith, " that there was a febrUizmg 
intiuenee present in our atmosphere the whole of the year 1828, 
as was manifest from its effects, for scarcely a month passed 
without cases of sporadic Yellow Fever occurring." 

^' The occurrence of sporadic cases of this disease in years 
not epidemic," says Mr. Howell, " is confirmed by the general 
course of events at the beginning of the late epidemic. The 
alleged first cases (those of Fenic's children) struck their medi- 
cal attendant with no surprise or alarm ; if these cases had 
presented appearances which he had not been accustomed 
occasionally to see- — even what is described as 'the fatal symp- 
tom of black vomit' — he would naturally have been astonished 
and alarmed at the occurrence of a disease foreign to his prac- 
tice. In the earliest cases, no medical man who had not wit- 
nessed an epidemic denounced the appearance of an unknown 
disease unusually rapid in its progress, or marked by any 
unusual symptoms, nor did any medical man who had witnessed 
an epidemic suddenly proclaim to the community his having 
for the first time since the year 1814, seen a case identical with 
that disease, and warn the public of the recurrence of a malady 
from which they had been for fourteen years exempt. On 
the contrary, judging of men's real opinions by the safest 
criterion, their own acts, I find that the circumstance which 
caused experienced as well as inexperienced medical men to 
announce the presence of the Yellow Fever epidemic was not 
the occurrence of one, of two, or of more cases, but the gradually 
increasing number of cases of the same disease, from day to 
day, in the same district of the town that it was not by any- 
thing unusual in the nature of the disease, but by something 
unusual in the number of cases, that the advent of a Yellow 
Fever epidemic was ascertained." 

An attempt was made before the Commission of 
Inquiry to discredit the fact that these alleged sporadic 
cases were really cases of Yellow Fever. Ol this attempt 
one of the Commissioners, Mr. Howell, gives the follow- 
ing account : — 

Mr. Fraser, in support of his opinion that the disease was 
indigenous, presented to the Board a list of thirty-nine cases of 



established before the Commission of Inquiry in 1828. 



19 



Yellow Fever, recorded in the case-books of the Civil Hospital 
as having occurred in years when no epidemic prevailed. To 
counteract this, evidence was adduced to show that some few 
of the patients in these sporadic cases had suffered the fever in 
some epidemic season, whence it was intended that we should 
infer that the cases presented by Mr. Fraser must have been 
cases of some other disease. 

" Had this been satisfactorily proved, the credit of the case- 
books, and the testimony of Messrs. Fraser, Wilson, Dix, Browne, 
and Gillice, might have been in some measure shaken, inas- 
much as it had been decided by the Report of a Medical Com- 
mission that ' one attack of Yellow Fever preserves the indi- 
vidual from a second.' 

In opposition, then, to Mr. Fraser's list, the hospital 
patients themselves in some instances came to depose to their 
having had the Yellow Fever in some epidemic year ; and in 
other instances, when the patient himself was dead, or not to be 
found, his relatives, or some one who said he knew him, gave 
evidence to the same effect. No medical evidence whatever 
was produced ; but the bare insertion of a bricklayei*, a labourer, 
or a journeyman butcher Cthis was the occupation of Sabah, as 
deposed by himself, though it does not appear upon the minutes), 
was given as evidence capable of outweighing the professional 
opinions of the medical attendants of the hospital supported by 
the entries in the case-books. On a professional point such 
impeaching evidence would be worthless under any circum- 
stances; but on this particular occasion the impropriety of 
receiving it as conclusive is aggravated by a remarkable 
instance of inconsistency. 

" The Report of the Commission, which is made the test of 
the hospital cases, contains the following sentence : — * Four 
physicians had attended in 1828, some patients who said that 
they had had the Yellow Fever in one or other of the former 
epidemics ; but as the symptoms of the first attacks could not 
be stated, the Board could not take these cases into considera- 
tion.' Now as it is certain that no symptoms were stated to 
the Board by the journeyman butcher, or his colleagues in their 
attempt to shake the credit of the hospital cases, it would seem 
to be particularly unfair to admit, as sufficient to overturn 
these cases, such evidence as would have been rejected by the 
Commission whose Report is made the foundation of this line of 
inquiry. 

" Ihe same evidence, to establish the same fact, cannot be 
good in one place, and bad in another. If good against 
Mr. Fraser's cases, the Report of the Commission, which ex- 
cluded such evidence as bad, must of course be itself worthless, 
as being founded on insufficient testimony, and then the fact 
found by that Report cannot be assumed as a test to try any 



20 Attacks frequently confined to one or two Members of a Family. 



question whatever ; but if such evidence be bad, and the Medi- 
cal Commission were right in rejecting the loose assertions 
of ignorant men, unsupported by any specification of symptoms, 
or by the testimony of a medical attendant, then the evidence 
of Sabah and the rest must be rejected by W5, and the genuine- 
ness of the Civil Hospital sporadic cases stands unimpeached." 
— Bee Certificate, Appendix I., p. 155. 

That Yellovi^ Fever constantly occurs as a sporadic in 
those parts of America in which it occasionally prevails 
as an epidemic, is proved by the general testimony of the 
medical men of such districts. Without multiplying 
examples, it may suffice to cite the statement of Dr. Hort 
of New Orleans, who says, — ■ 

" Until within three years past, during which time the fever 
has been rather sporadic than epidemic, the Yellow Fever pre- 
vailed with regularity as an epidemic every other year, but 
there were always sporadic cases." 

Dr. Arbuckle, of Pernambuco, writing to his brother, 
states that a Brazilian lady died of Yellow Fever in that 
city on the 17th August, 1849, whereas the epidemic of 
that year, alleged to have been imported from Bahia, did 
not appear until December. 

Dr. Gavin states that in the recent Yellow Fever Epi- 
demics of French and Dutch Guiana, as well as in those 
of British Guiana, indubitable evidence of the presence 
of a Yellow Fever influence was present, two and even 
three months before the cases became so numerous and 
decided as to warrant the declaration of the existence of 
a Yellow Fever Epidemic. 

Among the concluding remarks appended by Mr. 
Watson, surgeon of the Naval Hospital, Port Royal, 
Jamaica, to an elaborate return of all cases of fever 
admitted into that establishment from 1815 to 1849 
inclusive, occurs the following : — 

" We constantly meet with sporadic cases of the most fatal 
character at times when the general health of the community is 
excellent." 

In Yellow Fever, asin Cholera, when the disease breaks 
out in a family, it does not in general spread through the 
family, but attacks only one or two members, the rest 



Frequent limitation of Yellow Fever to particular Spots. 21 



escaping, even those in the closest attendance on the sick ; 
and when, as does occasionally happen, several individuals 
in the same family are attacked, it is found on inquiry 
either that the epidemic was general in the locality in 
which such family resided, or that the individuals attacked 
had gone into a locality in which the disease was prevalent. 

" The numerous instances," says Mr, Amiel, of two, three, 
or more persons having been attacked in the same house, at the 
same time, and even at the same hour, and that general suscep- 
tibiHty which so rapidly pervades all ranks, show, not that the 
disease has the property of spreading from person to person, but 
rather that it is produced by a general cause, to the influence of 
which they have been simultaneously exposed." 

In Yellow Fever, as in Cliolera, instead of the disease 
spreading from house to house in the district or locality 
which it invades, it is often confined in the most remarkable 
manner to particular houses in the same street, to par- 
ticular houses on one side of the street, and even to par- 
ticular rooms in the same house. Dr. Fergusson states, 
that he often observed the influence of the infection to he 
so limited, that one story of a house, or one section of a 
ship would be strongly affected, while the other parts of 
the same tenement remained healthy. It is recorded that 
during the epidemic which prevailed at Barbados in 
1838, of 36 individuals residing in a building appropriated 
as quarters for the officers, 28 Avere attacked of whom 10 
died ; whilst of the whole regiment residing in the soldiers 
barrack, at so short a distance as fifty paces from this 
fatal spot, only 30 cases occurred and none died. On other 
occasions it was observed that in certain barracks and 
hospitals, the very diagonal of particular apartments af- 
forded an accurate demarcation of the safe and unsafe 
position of beds ; and in ships the disease is often confined 
to men whose berths are on a particular side, or in a par- 
ticular part of a ship. The causes of these attacks may 
be ascertained by careful examination. 

Particular stations," says Mr. Amiel, " as North and South 
Flat Bastions, South Port, and the Convent Guards, were found 
to give rise to more concentrated forms of the fever than others, 
and the soldiers were attacked in greater number on these than 
on the other guards; and it is worthy of remark that, with one 



22 Seclusion ineffectual in preventing attacks ; often injurious. 

exception, these posts were on the line, or immediate vicinit}^ of 
the drains leading from 24th district. 

" The line-wall, skirting the sea-beach, was also discovered to 
be a very mortal station. Few sentries planted there, if any, 
escaped an attack ; and Colonel Payne, commanding the artil- 
lery, who remained in the town from the commencement of the 
fever until his death in the month of December, lost his life by 
visiting the locality at night. The known mihealthiness 6f this 
station caused many of the sentries to be withdrawn from it at 
night, and the consequence was some depredations were committed 
on the great guns ; and the Colonel, in his zeal to detect the 
offenders, perambulated this district for three successive nights, 
and on the third was suddenly attacked, and expired on the fourth 
day of his illness. 

The examples of people enjoying immunity from situation 
alone, though in constant communication with the sick, might be 
multiplied without number. In the same house even, families 
occupying the upper stories were known to escape, while those on 
the ground floor suffered severely. 

" In Bossano's house at Rosia, for example, many individuals 
in the upper story escaped the disease, while every person in 
Belasco's family, living directly under them, and who had not 
passed the fever, were attacked. In another house in the south, 
16 individuals died on the ground-floor, and not one was taken ill 
on the upper. 

" On the other hand, there were localities to which the disease 
never spread, and in which it seemed incapable of existing, as 
the Neutral Ground, Europa Flats, and the Bay. Our late 
epidemic could not be propagated in any of these localities." 

In Epidemic Cholera the most rigid seclusion affords 
no protection ; so in Yellow Fever epidemics, instead of 
increasing, it appears rather to lessen the chance of escape. 

*' In the army of St. Domingo," says Dr. Fergusson, it 
was notorious that those who were the most careful to seclude 
and shut themselves up, were ever the first to be taken ill, and 
the surest to die ; and during the Yellow Fever epidemic of 
1816, at Barbados, I have recorded remarkable instances of 
the same, both from my own observation, and that of others.'* 

It was the same during the Barcelona epidemic of 
1821 and the Gibraltar epidemic of 1828. 

" Families," say the Committee of Physicians of Barcelona, 
*^ who isolated themselves in their houses, employing the most 
exact precautions for avoiding external intercourse and commu- 
nication, did not by such means preserve themselves from the 
maladv." 



Deaths mnojig Persons secluded i a Dockyard, Gibraltar, 1813. 23 



Many families in Gibraltar/' says Dr. Smithy " secluded 
themselves without escaping the disease, and I myself witnessed 
numerous instances of this." 

" Shutting up houses/' says Mr. Amiel, burning furniture, 
and prohibiting intercourse with the sick, have had no eiFect in 
checking the progress of the disease." 

When the alleged cases of security afforded by seclusion 
come to be examined, it is generally found that they are 
without any real foundation. Of this the following 
may be cited as examples. In speaking of the Yellow 
Fever epidemic which prevailed at Gibraltar in the year 
1813, Sir William Pym states: — 

" Of 500 persons confined to the dock -yard during all the 
time of the sickness, there was not an instance of one of them 
being attacked." 

Again, he says : — 

" The lahourers belonging to the naval works have been kept 
in strict quarantine in the dock-yard, very near the spot where 
the disease showed itself in 1810, and if there is a situation in 
Gibraltar favourable to the generation of marsh miasmata it is 
there ; and in 1804, it shared the fate of the other parts of the 
garrison ; yet those people this year have continued healthy, as 
well as another party of inhabitants, who established themselves 
in Camp Bay, and cut off all communication with the infected." 

Dr.Gillkrest quotes from Dr. O'Halloran the following 
comment on this passage : — 

" The perusal of the foregoing quotations in the work of Dr. 
Pym struck me forcibly on my arrival at Gibraltar in the pre- 
sent year. 1 thought the immunity of the dock-yard from 
fever in the year 1813 a singular circumstance, and one which 
strongly operated against the doctrine which I am inclined to 
embrace. I had not doubted the assertions of Dr. Pym and 
Mr. [W. W.] Fraser ; for, from their rank in the service, the 
one being at the head of the Health Office in London, and the 
other at the head of the Medical Department in Gibraltar, it 
was reasonable to expect information of authenticity, for their 
opportunities of attaining it exceeded that of others. It hap« 
pened, however, by accident, that a medical gentleman, who saw 
the epidemic of 1813, observed, in the course of conversation, 
that fever prevailed to some extent in the dock-yard that year ; 
and that, by an application to Mr. Buck, who was secluded 
with the others, and who is now the superintending officer in 
charge of the establishment, particular and authentic informa- 
tion might be obtained on the subject. 



24 



Alleged Seclusion at Gibraltar in 1828. 



I applied to Mr. Back, and the information which I have 
obtained from him and his head clerk is the following : it may 
be depended upon as officially correct. 

" The number of persons secluded, according to Mr. Buck's 
account, who examined the books in my presence, amounted to 
170. Dr. Pjm makes it 500." 

Dr. O'Halloran then quotes from the records of the 
dock-yard the names of the persons who were there at- 
tacked with Yellow Fever, together with the names of 
those w4io died of that disease, amounting in all to 24, 
of whom 16 recovered, and 8 died, or 1 in 21 of the 
persons secluded. The dock-yard authorities concluded 
the certificate, which they gave to Dr. O'Halloran, in the 
following words : — 

" The truth of the assertion as to deaths having taken 
place there (the dock-yard) cannot be doubted, and the list of 
sick falls far short of the numbers affected ; but the dread of 
being sent to the Lazaretto, and being separated from their 
friends and relations, caused the sufferers to conceal the disease 
in many instances." 

Dr. Gillkrest confirms by his own personal examination 
the correction thus given by Dr. O'Halloran. 

" During my residence at Gibraltar," he saj^s, " I had ample 
means, by referring to the official authorities at the dock-yard, 
of confirming the assertion of Dr. O'Halloran that several cases 
of the fever prevalent in 1813 occurred there, as well as some 
deaths ; but to my utter astonishment I found Sir William 
Pym's statement repeated in the second edition of his work 
(page 34) printed in 1848, though he had been twice in 
Gibraltar after the error had thus been publicly exposed." 

In like manner Sir W. Pym, in enumerating several pri- 
vate families who escaped an attack in 1828 by cutting off 
all communication with the infected, places in this number 
the family of Judge Howell; but Mr. Howell authenti- 
cated before the Board of Inquiry, of which he was a 
member, the evidence v/hicli he had previously given to 
the Anglo-French Commissioners, which was to the 
effect, that he had not secluded himself ; that he was 
in the constant habit of receiving people on business into 
his house — paymasters of regiments, for example, to swear 
to their pay-lists, and many others ; and that Mr. Amiel, 
Surgeon of the 12th Regiment, had been in the habit of 



Advantages of removal from Infected Districts. 25 



visiting his family often directly after leaving the wards 
of the hospital. 

During the late Cholera epidemic, the most striking 
examples occurred of the sudden cessation of the pestilence 
on the removal of the population, whether sick or healthy, 
from the infected localities ; in like manner, the history of 
Yellow Fever epidemics abounds with similar instances. 

Dr. Gillkrest gives numerous examples of this in Ap- 
pendix No. ], page 202. — Dr. Smith states, that on the 
outbreak of the disease in the 12th Regiment, this corps 
was immediately encamped on the Neutral Ground, and not 
a single fresh case occurred until the regiment again re- 
sumed night duties in the town. Mr. Amiel, surgeon of 
the regiment, confirms this statement in the following 
words : — 

" The 12th Regiment was removed to the Neutral Ground on 
the 5th of September, after having sent four cases of fever to the 
12th Hospital, two of which died with the dreadful symptoms 
of black vomit; but from the period of their encampment until 
the 25th of September, the soldiers having had no duty to per- 
form in the town, no fever cases appeared among those in the 
camp, while several orderlies attached to the different depart- 
ments which remained within the garrison were attacked. It was 
from the 25th of September, when the regiment had resumed the 
town duties, that is to say, when the soldiers came to breathe the 
pestilential exhalations in their stationary sources, that the admis- 
sions became numerous and the increase of the disease alarminor." 

The disease also broke out early in the 23rd Regiment, 
quartered in Rosia barracks. The regiment was en- 
camped at Europa Flats, after which not a single case 
occurred among the men, who never left the camp. 

" The most signal success," continues Mr. Amiel, has fol- 
lowed the removal from the impure atmosphere of the Rock of 
those who appeared most susceptible of the fever, as was done in 
1813 with many thousand inhabitants, in 1814 with the sickly 
regiments, and during the late epidemic with the whole population 
of the 13th and 24th districts. 

" In 1814 the Regiment of Dillon, which had arrived in the 
month of May, was quartered, at the breaking out of the epidemic, 
in the Blue Barrack, near the Moorish Castle. A great number 
of men took the fever and soon died; in consequence of which the 
regiment was encamped on the Neutral Ground, and immediately 
the fever stopped. 



26 



Salutary effects of Removal in quickly checking 



The 8th battalion 60tli Regiment, arrived from Cadiz in 
August of the same year, and encamped on the Governor's mea- 
dow in a heahhy state. Shortly afterwards they went into the 
Cooperage Barracks in town ; the fever soon broke out amongst 
them, and both the officers and men suffered severeh\ They 
were sent back to the encampment, and the disease instantly 
ceased as if by magic." 

Mr. Melvin states, that on two occasions he succeeded 
in putting an immediate stop to severe visitations of Yellow 
Fever among the troops, by removing the men from the 
infected locality, and that the effect of tlie removal on 
the sick was instantaneous. 

" Some of the cases," he says, " were bad ; one of them at the 
time was bringing up large quantities of black vomit, and had 
much haemorrhage from the gums and nose, with an exceedingly 
cadaverous and disagreeable smell emanating from his body ; 
in fact, he in every way aj^peared to be quite hopeless. How- 
ever, to my delight, this case, as well as every other, perfectly 
recovered, which most assuredly would not have been the case 
had not the change of situation been made. And to my fur- 
ther delight and comfort, I had not a single servant attacked 
with Yellow Fever, nor did I lose a single case from it while I 
occupied this old hospital ; but I had cases of regular Yellow 
Fever among some of the families in the barracks. During the 
period I have been speaking of, I attended the sick of the 
^vhite troops entirely myself. With regard to the ground 
about this old hospital which I had the sick taken to, it was 
well drained, and, above all, it was out of the influence of the 
new marshy and muddy ground so very close to the new re- 
gular hospital." 

Dr. Spence states, with reference to the fatal spot oc- 
cupied by the officers in the garrison of Barbados, in 1838, 
w^here out of 36 residents, 28 were attacked with Yellow 
Fever ; it was recommended that the quarters should be 
evacuated forthwith, and forthwith the fever stopped, for 
after the adoption of this measure not one case occurred. 

''When Yellow Fever makes its appearance in a particular spot,'' 
says Dr. Davy, removal from that spot is the true measure of 
security ; sometimes removal to a short distance, as of a few hun- 
dred yards, would appear to be sufficient ; but, if it be practicable, 
removal to a greater distance is desirable, and to ground in its cha- 
racter different from that where the disease originated. Late expe- 
rience in Barbados proves the propriety of this. When Yellow 
Fever broke out in the 88th Regiment, occupying the lower bar- 



various outbreaks of Yellow Fever in the West Indies. 27 



racks in the garrison of St. Ann, the encamping of them on 
ground close 1o the higher barracks^ in the same garrison occu- 
pied by the 7th Royal Fusiliers, who were then free from fever, 
and altogether escaped it, was successful. The same result 
occurred, for a time, when the disease appeared shortly after in 
the 66th Regiment, who followed the 88th, in the lower barracks : 
their removal to the higher ground at first appeared to be suc- 
cessful, but only for a while. Ere long the fever made its appear- 
ance in the upper barracks, then occupied by the 72nd Regiment, 
and 'indeed appeared more or less throughout the garrison. With 
the experience I now have, and the strong conviction in conse- 
quence, I am satisfied that in the instance of this outbreak of 
fever, whether in the 88th, 66th, or 72nd, the recommendation on 
the part of the medical officer, when consulted by the general 
oflScer commanding, would have been best given in conformity 
with the above, to remove the regiment attacked, not from one 
part of the garrison to another, but to a greater distance, and to a 
situation altogether different from that where the disease had made 
its appearance. Having, in my capacity of Inspector-General 
of Hospitals, been the medical officer consulted on the occasion 
referred to, I have the less hesitation in making: these remarks. 
Whether, in a military point of view, such a removal of the 
troops from the garrison to a distance could have been effected 
with propriety is altogether another consideration. Life^ it must 
be remembered, in the army, must always be held subordinate to 
duty ; and it should be remembered, too, that there are many 
instances on record where a removal to a very short distance has 
been effectual. With the medical officer the preservation of life is 
the only consideration ; with the general officer, duty is the first 
consideration." 

The testimony is uniform, that the removal of the 
sick takes pLice without transmission of the disease. 
Dr. Cherrin says — 

" In 1802, Admiral Gravina caused 500 patients with Yel- 
low Fever to be disembarked at Cadiz, who were taken to the 
hospital St. Juan de Dios, and treated therein, without having 
communicated their malady to any person." 

The same author shows, by the concurrent testimony 
of the medical men of upwards of thirty cities and towns 
in North America, that the arrival in these places of 
persons labouring under the most malignant form of 
Yellow Fever was followed by no communication of the 
disease. 

Dr. Ashbel Smith, describing an outbreak of Yellow 
Fever at Galveston (Texas), says — 



28 Encampment of Troops on Neutral Ground, Gibraltar, 1828. 

" The sick have been in many instances removed from the 
infected district to healthy sections of the cit}-, and in no case^ 
as far as I can learn on careful inquiry, have the attendants 
or inmates of the houses contracted the disease." 

At the commencement of the Gibraltar epidemic (1828), 
the population of the districts first infected, consisting of 
about 4,000 persons, abandoned the town by order of the 
authorities, and encamped on the neutral ground. They 
took with them their bedding and other household furni- 
ture. They took with them their sick and the families 
of the sick; but the disease, instead of spreading through 
the camp, was immediately and completely arrested. 
Great numbers of the poor, as soon as they had passed 
through Yellow Fever m the Civil Hospital and were con- 
valescent, rejoined their families in the camp, taking with 
them their blankets and other personal articles, yet there 
is no known instance in wdiich they communicated the 
disease. 

''^Several of the women/' says Dr. Smith, passed the night in 
the same beds with their husbands attacked with, and labouring 
under, the epidemic fever, and, besides, continued, as well as their 
numerous children, to use the same bedding after the men had 
been removed to hospital; but in no instance was the disease 
contracted by the wife or the children, even after that fail 
exposure." 

Out of 92 women and 190 children, belonging to the 12th 
regiment," says Mr. Amiel, ''who were not allowed to pass Bay 
Side Barrier (the entrance into the garrison), not one had the fever, 
though several of them slept in the same beds with their husbands 
labouring under the epidemic, and continued to use the same 
beddincr, 

" It has been said, that the pure air of the Neutral Ground 
checks the contagious property of the fever ; but when the wife in 
the same bed came in contact with the patient scorched with 
febrile beat, or bedewed with copious perspiration, when she 
inhaled under the same tent the effluvia of his breath, how could 
the air, however pure, sufficiently interpose to prevent the process 
of contagion, and its fatal consequences ? 

"From the foregoing observations, I conceive it results that the 
disease does not spread when the sick are removed from the impure 
air in which it was contracted, and likewise that, by breathing the 
impure air without exposure to the contact or effluvia of the sick, 
persons are frequently attacked ; while, on the contrary, without 
breathing it, however exposed to such contact or effluvia, no 
person is attacked." 



Effects of Migration from Barcelona and other Places. 29 



During the Barcelona epidemic of 1821, the experience 
was similar. 

A great number of persons/' say the Committee of Physi- 
cians, '*^vvho, after passing the whole day in the capital, retired at 
night to their iamilies, either in country-houses, or in the nearest 
villa2^es, commimicated the disease to no one, whatever were the 
situations of these houses; not even those who had quitted the 
town on the very day on which they had lost a member of their 
family, and notwithstanding their having taken no precautions. 

The daily traffic of carriages which had conveyed sick per- 
sons furtively introduced, or mattresses, linen, clothes, and other 
furniture, taken from the very focus of infection, did not transport 
the malady beyond the limits which had been assigned to it. 

Notwithstanding the crow^ds squeezed into the smallest habi- 
tations, the general panic, the heat of the w^eather, and the com- 
bination of many other causes well calculated for the propagation 
of disease, however destitute that disease might be of any conta- 
gious property, it could not be transplanted out of the city. 

Soon after the outbreak of the epidemic at Leghorn in 
1804, 6,000 persons left that city for Pisa ; at the same 
time the French army removed to the same place, taking 
with them 180 men labouring under the disease, yet there 
was no propagation of the disease at Pisa. 

Testimony is borne by Humboldt, that the experience is 
the same at Vera Cruz, where he states it is the practice 
to remove the sick as extensively as possible from the city 
into healthy districts. " Not only at Xalapa and higher 
" up in the interior," says this distinguished observer, but 
" at the farm of Encero, a short distance from Vera Cruz, 
" the disease is found to confine itself to the persons of 

those who may arrive with it in their systems, notwith- 
" standing the freest intercourse with others.'' 

During the recent epidemic in Brazil, many of the 
residents in Rio de Janeiro, in order to escape the disease, 
fled to the town of Petropolis : several of the fugitives 
were attacked after their arrival there, but in every in- 
stance wii:hin three or four days from the time of their 
departure from Rio ; and no inhabitant of Petropolis who 
had not been to Rio, is known to have suffered, though 
several who did go into that city had the disease and 
died. ''The disease," says one of the witnesses, ''was 
'' contagious only within Rio itself!" 

" The disease then existed at Petropoliy," says Dr. Croker 



30 



Patients in Hospital for other Diseases 



Pennell, with sufficient violence to destroy a large proportional 
number of lives ; for it is believed that the eleven deaths which 
took place formed a high rate of mortality compared with the 
number attacked. It is probable that at least seven persons 
held communication with each individual who died, either as 
attendants, nurses, or in washing or burying him ; so that we 
are thus presented with an instance of from 70 to 80 persons 
exposed to a violent infection, if such it be, and singular to 
relate not one contracted the disease : not a single resident at 
Petropolis caught the fever." 

The testimony borne by naval and military surgeons is 
almost uniformly to the same effect. 

On the outbreak of the epidemic at Gibraltar, Yellow 
Fever patients were freely admitted into hospital, when 
there were men with other diseases in the same wards. 

" Yet," says Dr. Smith, " I never observed any mischief to 
result, although no precautionary measures were adopted. 
The hospital servants escaped until the disease had become 
general in the district where the hospital is situated. The 
officers, also, who confined themselves to the camp, escaped, 
although some of them accompanied their sick companions to 
hospital, rendering them every kind office, and sitting with them in 
the same waggon which conveyed them to hospital. 

The convalescents were discharged directly to their regiments 
without their hits or wearing apparel being submitted to any 
process of purification. I myself had daily communication with 
the camp. * * * j^-j Civil Hospital, such was 
the pressure for admission into that institution, as to render it 
necessary to reliev^e the wards the moment a patient passed the 
acme ol disease; accordingly, convalescents were discharged in 
all stages, many of them having blood exuding from their gums; 
and to some very poor people the soiled blankets under which 
they had passed the disease were given to them. The majority 
of these people went to the Neutral Ground, where they recovered 
rapidly, and where they slept with their families as usual, and 
mixing with whom they pleased." 

'''Several cases of the epidemic," reports Mr. Amiel, '^were 
admitted into the Regimental Hospital, three of which died 
with the black vomit ; but the disease never attacked any of the 
other patients, more than tv.'enty in number, treated during the 
above period for other complaints, nor any of the orderlies, who 
had, as usual, an incessant and unreserved intercourse with the 
dyincr, and slept in the same wards." 

*''l'he epidemic," continues Mr. Amiel, ''did not spread, at 
Europa Flats, on board of the vessels in the bay or on the Neutral 
Ground, when carried thither from the town; and numbers of 



not affected hy contact with Yellow Fever Patients. 



31 



individuals who had the seeds of the disease about them, even in 
the case of their falling sick or there, did not communicate 

the malady to their neighbours or attendants. This important 
fact, which I had particularly noted during the epidemic of 1813, 
amongst the foreign recruits quartered at the Brewery Barracks, 
has been most forcibly exemplified during the late calamity, when 
neither the bedding, clothes, &c., removed from the focus of sick- 
liness, nor the continual intercourse with some of the inhabitants 
who daily w^ent out to the Neutral Ground, nor the numerous 
convalescents directly sent thither from the Civil Hospital, often 
in an early stage of their recovery, produced a solitary case of the 
disease beyond the gates of the garrison among that numerous 
population who had fled thither, and who frequently were in con- 
fined habitations, when the heat of the weather, the depression of 
spirits, the melancholy scene which they witnessed, and, I may 
add, for many of them, privations and hardships, afforded the 
most favourable means for the propagation of the disease, had it 
been of a contagious and communicable nature." 

" During the late epidemic of British Guiana," says Dr. Blair, 
the Yellow Fever cases in their worst forms were never sepa- 
rated from other patients in our hospital wards. Such a thing- 
was not deemed necessary, and never thought of. They were 
classified with acute cases. Our hospital nurses never got 
infected^ although in the closest connexion with the sick, and 
often smeared vdth their ejections ; and these nurses were 
generally German and Portuguese immigrants. The resident 
surgeons, dispensers, and stewards, were all susceptible subjects, 
and, with one exception about to be named, escaped without 
an attack. Mr. Bell, the first dispenser of the Seamen's 
Hospital, then lately from England, spent several nights in 
Water-street attending on a sick friend. Mr. Huddleton got 
Yellow Fever, and died the night he v/as gazetted to his ap- 
pointment, and never did one day's duty at the hospital. Cer- 
tainly his friend had the same disease, but Mr. Bell caught it, as 
Mr. Huddleton had caught it, in Water-street. The way to give 
a Yellow Fever nurse the Yellow Fever, was not by bringing him 
inclose contact with the sick, but by discharging him or her from 
the hospital. After knocking about town for a few weeks, and 
getting into the malarial districts, they would, it is likely, be 
brought to the hospital as Yellow Fever patients. Several nurses, 
discharged for bad conduct, suffered in that way. Dr. Bonyun, 
then one of the resident surgeons of the Seamen's Hospital, and 
not long from Europe, slept continuously in the Seamen's Hos- 
pital while it was crowded with Yellow Fever, without suffering 
from the disease, and without fear of contagion. 

" In December, 1843, the mate of the ^ Matilda Luckie ' was 
admitted with the gravior form of the disease, and of a low type, 
of which he died. His bed was in a sheltered corner of Ward 



32 



Medical Men, Nurses, and other Attendaiits 



No. 2, and had mosquito netting all around. Into this bed a sea- 
man, named Burton, who was admitted for disease other than 
Yellow Fever^ — slight indisposition — was put for several days 
without any infection of any kind following. Neither was such 
an experiment deemed hazardous to the subject;, nor objection- 
able, except on the score of cleanliness. Experiments made by 
me on the muco-purulent looking matter which frequently 
exudes from the eyes in the late stages of Yellow Fever, applied 
to healthy conjunctivae, showed that though slight ophthal- 
mia followed, no Yellow Fever contamination was the result. 
Many ships lost ' hands ' after their departure from port, and 
were obliged to put into Barbados and other islands for addi- 
tional men ; but we never heard of any spread of Yellow Fever 
among the islands in consequence. None of the Georgetown 
medical practitioners suffered from the Y^'ellow Fever except 
Dr. Fraser and myself. The disease picked out the new comers 
of an establishment, and no reluctance was felt, either by friends, 
or relatives, or acquaintances, to perform any service for the sick." 

On a spontaneous outbreak of Yellow Fever on board 
Her Majesty's ship " Bedford," when in Gibraltar baj^, 
there being at that time no fever in the garrison, 130 sick 
were landed and sent to the hospital ; eleven died, and 
others were left dangerously ill on the departure of the 
ship. The disease did not extend beyond the crew. 

In the year 1830 a similar outbreak of Yellow Fever 
attended with black vomit, occurred in Her Majesty's ship 

Blossom," in Belize harbour: forty-eight cases were 
received into the military hospital there, and two officers 
and eight men died. The disease did not extend to other 
ships or to persons on shore. 

Mr. Hartle, deputy inspector general of hospitals, who 
served in the ^'^^est Indies during a period of more than 
30 consecutive years, states, that he has on several occa- 
sions witnessed the importation of Yellow Fever cases 
of the most malignant character, amounting in all to 107, 
but that he never observed in a single instance the com- 
munication of the disease to any individual. 

Mr. Mortimer, principal naval medical officer at Bar- 
bados, says : — 

" We have never heard of an instance of its communication 
to patients at the several naval hospitals whilst under cure 
for other complaints, though such patients have never been 
interdicted, on the contrary, encouraged to offer any additional 
aid for the greater comfort of their suffering brethren." 



not affected hy contact with Yellow Fever Patients. 33 



" At Barbados/' says Dr. Fergusson, " our hospitals of late 
years have been in a regular course of importation of the 
Yellow Fever from the navy ; but not even inoculation has 
been able to produce the disease upon any member of the 
hospital corps, by whom I may truly say that the sick have been 
received u ith open arms ; for the anti-social doctrines of ideal 
contagion are not preached among us here to the prejudice of 
duty and humanity." 

Dr. Magrath, Principal Medical Officer of the Public 
Hospital in Kingston^ Jamaica, whose opinion, derived 
from an experience of 34 years on the island, is of the 
highest value, says — 

Yellow Fever has not for several years prevailed as an epi- 
demic in Kingston, but occasionally we receive patients suffering 
from it into the public hospital. Most of these cases come from 
coal ships. In 1848 the crew of a vessel that had a few months 
previously been employed in carrying guano, suffered most severely ; 
and in 1849 the persons on board two coal ships, which, after dis- 
charging their cargo, took in some impure ballast, were attacked 
with Yellow Fever in its most virulent form, whilst all the other 
vessels in the harbour remained nearly free from the disease. 
The sick from these ships were placed amongst the other patients 
in the hospital." 

Dr. Magrath informed me," reports Dr. Milroy, tiiat 
nearly 20 cases of aggravated Yellow Fever were received from 
these two vessels, (the holds of which were found to be in the foul- 
est state imaginable,) into the hospital, and a very large propor- 
tion of them proved fatal. None of the other inmates or of the 
attendants of the hospital were affected. Moreover, there was no 
prevalence of the disease on shore at the time. 

Dr. Dunn, another eminent practitioner in Kingston, men- 
tioned to me, that when he was Health Officer at Old Harbour, 
cases of malignant Yellow Fever were every now and then occur- 
ring in the shipping there, while none existed among the inhabitants 
of the place. 

^' 1 may mention that so frequently was the occurrence of Yellow 
Fever observed to take place on board vessels in Kingston har- 
bour when they took in the foul shingle from the shore at or near 
the wharves, where there is always an accumulation of filth and 
refuse, that of late years they have been required to proceed 
to the palisades on the opposite side of the harbour for ballast 
when necessary." 

Dr. Milroy adds: — 

Dr. Chappie, one of the Spanish medical officers of the mili- 
tary hospital in the Havannah, informed me that the disease is 

D 



34 Occasional Attacks in Hospital attributable to the locality , 

by no means unfrequent, and occasionally prevails with great 
severity among the patients in that institution while the city is 
nearly or altogether exempt from it. The hospital is notoriously 
unhealthy from obvious local causes ; and it is an interesting fact 
that, during tlie late visitation of cholera, the disease clung in a 
veiy remarkable manner to this building/' 

When the attendants on the sick in hospitals do become 
the subjects of the disease, it is, as has been already stated, 
only after the epidemic has invaded the locality in which the 
hospital is situated ; an observation in perfect accordance 
with the experience of Cholera in Hamburgh and other con- 
tinental towns as well as in Great Britain. During the 
epidemic at Gibraltar in 1828, all diseases belonging to 
six regiments were for several weeks received into the naval 
hospital. Yellow Fever indiscriminately with the rest; but 
none of the other patients were attacked until the fever 
had become prevalent in the district in which the hos- 
pital is situated. 

" The danger," say the Committee of Physicians at Barcelona, 
so far from being in the direct ratio of exposure (contact or inter- 
course with the sick) was positively (in many instances) in the 
reverse ratio. 

*' In the marine lazaretto in which from the 7th of August to 
the 13th of September there entered 79 sick (of whom 55 died, 
and 24 recovered), not one out of 32 of all classes of officers and 
attendants, contracted the disease. 

" In the Lazaretto of the Vice-queen of Peru, which received 
56 sick (of whom 39 died and 17 recovered) ; out of 23 persons 
of various classes who attended them, four only contracted the 
disease ; and these had come out of Barcelona. 

In the Hospital of the Seminario, into which 1 767 persons 
were admitted during the epidemic (of whom 1293 died); out of 
90 attendants on the sick, three only contracted the disease, which 
is but at the rate of 1 in 30, constituting a far greater exemption 
from sickness than was enjoyed by any other portion of the com- 
munity. 

In (he General Hospital, while the fever attacked persons 
who had no communication whatever with the sick or their effects, 
the vicars, the brothers and sisters, who attended the patients with 
the purest charity, the physicians, surgeons^ &c., remained in per- 
fect health. 

It was not," says Dr. Gillkrest, speaking of Gibraltar, " until 
the residents in the southern district, where the hospital con- 
taining the sick of six regiments was situated, became affected 
with the noxious emanations that prevailed that any hospital 



or to Poison previously received in an Infected District. 35 



servant was attacked ; and the two first attacked were the cook 
and the waterman, whose duties never took them into the wards. 
Those of our permanent orderlies who suffered were for a month 
in close contact by day and night with the patients before being 
attacked. On the removal of the hospital to the barrack at 
Windmill Hill, an unaffected district not a single hospital servant 
or patient was subsequently attacked. 

• " One would naturally suppose," observes Dr. Fergusson, 
*^ that wherever a true infection existed, the hospital, where all 
the sick are congregated, would not be the place of safety ; yet 
there, notwithstanding, it is most likely to be found. Apply this 
touchstone : it will be seen that the medical officers never suffer 
more from the disease than their fair proportion, according to 
numbers ; and the more immediate white attendants, orderlies, 
and others, uniformly less, if the ventilation and discipline be 
good, than the soldiers in barracks who never go near the place ; 
because, while so employed they are saved from exposure to 
the sun's heat, to night guards and drunkenness. This I 
proved from incontestable hospital returns when I was last in 
the West Indies, as also that the supposed contagion w^as never 
communicated to the surgical sick, the convalescent and others, 
although occupying the most contiguous beds in the same 
hospital." 

With reference to the epidemic which prevailed at 
George Town, Demerara, from 1839 to 1846, the valu- 
able statistical tables drawn up by Dr. Johnstone, health 
ofl&cer of the port, show that within that period there 
were received into the colonial hospital 1725 cases of 
fever (399 of which are returned as Yellow Fever, and 
1326 as remittent), whilst 9,153 patients were under 
treatment for other diseases in the same establishment ; 
yet two only of the medical attendants were seized with 
fever (one of whom, had just arrived from Europe and 
the other had been much in Water-street and on the river), 
and three of the patients, whose attacks can also be 
satisfactorily accounted for otherwise than by contagion : 

they all came from the seat of the epidemic, and brought 

the seeds of the disease along with them." 

Again, in the seamen's hospital, during the same 
period, there were admitted 3,762 cases of fever, (2,544 
of which are returned as Yellow, and 1,218 as Remittent), 
with 3,422 patients for other diseases ; yet but 25 of the 
seamen previously in hospital (all coming originally from 
the focus of infection) were attacked with the epidemic, 

D 2 



36 Unanimous conviction of Medical Men in the West Indies 



whilst it can be shown by the records themselves, that 
these were not cases of contagion. 

''It is to be stated/' says Dr. Gavin, ''that the shipping and 
shore were the seats of the epidemic ; that 3,000 seamen died 
during the epidemic ; and that the seamen had been all more or 
less exposed to the influence of the poison before admission. 

"The fact," says Dr. Blair, "of the opinion of contagion in 
Yellow Fever being abandoned at Demarara by the unanimous 
consent of the entire community, professional and non-professional, 
who had countless opportunities of observing the disease spread 
over an eight years epidemic, in all its phases, and from every 
point of view, seems to me testimony and proof as strong as the 
subject is susceptible of." 

Dr. Milroy thus expresses the result of his observation 
and inquiry respecting Yellow Fever in Jamaica and 
Havannah ; — 

" There is one circumstance in the history of Yellow Fever 
which has made a strong impression upon my mind, as respects 
its general mode of diffusion, and it is this — The unanimous con-' 
viction of the medical men in Jamaica, and also of those in Ha- 
vannah whom I met, that the disease is not contagious or com- 
municable from the sick to the healthy. I had the opportunity of 
conversing with ihe resident medical men in every part of Ja- 
maica, and nowhere did I hear any difference of opinion upon this 
subject. 

" It is certainly a curious circumstance in the history of a dis- 
ease, that it should be almost universally regarded as not com- 
municable from person to person in those countries where it takes 
its origin, and is every now and then present either sporadically or 
epidemically, and where, consequently, the medical men must 
have constant opportunities of studying its character; while when 
it occurs in other lands, where it appears only occasionally, at 
distant hitervals, it is denounced as extremely contagious, requiring 
a rigorous quarantine. Can this strange feature be alleged of 
any other malady except of Yellow Fever? I do not remember 
an instance. The circumstance, too, of the comparative exemption 
of the black and coloured races, who certainly enjoy no immunity 
from smallpox and otlier acknowledged contagious diseases, is 
another fact which, to my mind, is very significant." 

It is not, however, surprising that those who for the 
first time see the sudden spread of a new form of disease 
should attribute it to contagion, whilst those more expe- 
rienced, accustomed to observe the same disease under 
various circumstances, should be convinced that it does 



that Yelloio Fever is not Contagious. — Humboldt. 37 



not owe its origin to that cause. Many diseases once uni- 
versally believed to be communicable from person to person 
are now believed to be so by none. As long as the real 
causes of disease were unknown contagion offered a ready 
explanation. 

Humboldt informs us in his Political Essay on tlie 
Kingdom of New Spain, vol. iv. p. 171, that persons 
born and brought up at Vera Cruz are not subject to this 
disease ; and it is the same at Havannah with those who 
do not quit the country. 

" It is incontestable," he says, " that the Vomito is not con- 
tagious at Vera Cruz. In most countries the common people 
consider many diseases as contagious which are of a very ditferent 
character, but no popular opinion in Mexico has ever interdicted 
the stranger not seasoned to the climate from approaching the 
beds of those attacked by the Vomito. No fact can be cited to 
render it probable that the immediate contact or breath of the 
dying person is dangerous to those not seasoned to the climate 
who may attend on the patient. On the continent of equinoctial 
America the Yellow Fever is not more contagious than the 
intermittent fevers of Europe." 

Dr. Fergusson sums up the result of his observation 
and experience on this part of the subject in the following- 
passage : — 

" No experienced men, unblinded by the prejudices of the 
schools and authorities, or unbiassed by the expectation of 
Quarantine office, can seriously believe it to be a contagion. It 
is a terrestrial poison which high atmospheric heat generates 
amongst the newly arrived, and without that heat it cannot 
exist ; but it affects no one from proximity to the diseased, and 
cannot be conveyed to any low temperature. This was finely 
exemplified at Port-au-Prince, St. Domingo, where I spent the 
earlier months of the year 1796. Our head quarters were the 
town and its adjunct, Brizzoton, as pestiferous as any in the 
world, and there we had constant Yellow P'ever in all its fury. 
At the distance of a mile or two, on the ascent up the country, 
stood our first post, Torgean, where the Yellow Fever appeared 
to break off into a milder type of Remittent. Higher up was 
the post of Grenier, where concentrated Remittent was rare, and 
milder Intermittent, with Dysentery, the prevalent form of dis- 
ease ; and higher still Avas F^ourmier, where Remittent was 
unknown. Intermittent uncommon, but Phagedenic Ulcers so 
frequent as to constitute a most formidable type of disease ; and 
higher still were the mountains above L'Arkahaye, of greater 



38 Mortality among Animals during Epidemics. 



elevation than any of them * * * * where a British de- 
tachment had always enjoyed absolute European health, only 
it might be called better, because the climate was more agreeable 
than in the higher latitudes. Here were the separate regions 
or zones of inter-tropical health, mapped out to our view as 
distinctly as if it had been done by the draughtsman. Taking 
Port-au-Prince for the point of departure, the three first could 
be traversed in the course of a morning's ride. We could pass 
from the one to the other, and with a thermometer, might have 
accurately noted the locale of disease, according to the descend- 
ing scale, without asking a question amongst the troops who 
held the post ; and what kind of contagion must that be which, 
amongst men in necessary intercommunication, cannot be con- 
veyed from the one to the other ? which refuses to mingle with 
another of lower temperature, although within sight, and so 
near, topographically speaking, as almost to touch ? The men 
could, and did, constantly exchange duties, but not diseases ; 
and it was just as impossible, and more so, to carry a Yellow 
Fever up the hill to the post in sight, as it would have been to 
escape had they been brought down and located amongst the 
swamps of Port-au-Prince. These things were known to every 
person in the army, whether medical, civilian or military, and 
amongst them all there was not to be found a single person who 
had the smallest belief in contagion, provided always he had 
been a year in the country, and possessed opportunity of see- 
ing with his own eyes : all, I may say, came out contagionists, 
myself amongst the number, none remained so. It was im- 
possible that we could, in face of the every- day experience of 
our lives ; and if we had, the very women and drummers of the 
army would have laughed us to scorn, because they had long' 
discovered there was not the smallest danger to be apprehended 
from the closest proximity of the sick. The woman knew that 
when she slept with and attended her dying husband she ha<]fe 
not been infected, and all were sensible that no safer duty could 
be imposed than that of attending the sick bed." 

The attacks of Yellow Fever, like those of Cholera,, 
are chiefly in the night. Dr. Smith, states that four- 
fifths of the patients who came under his observation 
were attacked at night. He also confirms a statement 
made by other observers, that in Yellow Fever, as in 
epidemic fever in general, but particularly in the typhus 
of European cities, the mortality is commonly less among 
the weakly and delicate, than the robust and strong 

Another resemblance between Yellow Fever, Cholera., 
and epidemic diseases in general is, that the epidemic 
poison, whatever it be, ailects animals as well as man. 



Comparative Mortality in different Localities. 39 



Many writers of eminence on Yellow Fever notice the 
concurrence of this pestilence with the prevalence of 
epizootic disease, and in many instances with an extra- 
ordinary predominance of insect life ; the epidemic poison 
apparently acting on animals in some such manner as an 
analogous morbid influence produces blight in plants. 

During the Gibraltar epidemic, an unusual mortality 
was observed among dogs, cats, monkeys, birds, horses, 
and domestic animals in general ; and many of these died 
with the characteristic symptoms of the prevailing epi- 
demic. In the Yellow Fever epidemic at Boa Vista in 
1845 and 1846, there was an extraordinary mortaUty 
among the cattle over the whole island, including cows, 
horses, mules, donkeys, and goats. 

The Spanish physicians have recorded similar observa- 
tions, and they further state, that over the extent of the 
locality affected by the morbific atmosphere, birds forsake 
their usual haunts. " Arejula informs us," says Dr. 
Gillkrest, " that he announced to the inhabitants of 
*' Malaga, that their epidemic was about to leave them, 
" because he saw the sparrows returning to their usual 
" haunts." 

Yellow Fever, like Cholera, is subject to no rule of 
gradual progression or proportional severity, but decimates 
certain localities, while it spares entirely, or visits but 
lightly, others in the immediate neighbourhood. From 
observations on West Indian garrisons, during a period of 
twenty years, it appears that the mortality from febrile 
diseases in Tobago is 104* 1 per 1000, while at St. Vincent 
it is only 11 • 2 ; at St. Lucia it is 63' 1, at Barbados II '8 ; 
in Trinidad 61-6, in Antigua 14*9. 

The differences are equally striking in different locali- 
ties in the same island. Thus in Jamaica, the mean 
mortality from fever for a period of twenty years has been, 
at Spanish Town, 141-1 per 1000, while at Fort Augusta 
it has been only 55*5; at Up Park Camp 121'0, at Stony 
Hill 70 5 ; at Montego Bay 150 7, at Maroon Town 15*3 ; 
at Port Antonio on the north side 126, and at Port Royal 
on the south 93*9. 

" In all the latter instances," says Dr. A. Browne, " with the 
exception of Port Antonio and Port Royal, the stations ai'e 



40 Comparative Mortality in different Localities, 

within short distances, the communications are frequent between 
them, and any contagious disease prevailing at the one might 
he easily transmitted to the other ; and Port Antonio was con- 
trasted with Port Royal, because the former is a small port 
where few ships, unless from England or North America, ever 
enter ; and Port Royal, on the contrary, is more frequently 
visited by vessels from every quarter than perhaps all the other 
harbours in Jamaica. 

" If we corroborate the preceding proofs of the localization of 
fever by the facts so clearly established by this excellent statis- 
tical Report ; viz., That epidemic Fever is rarely if ever absent 
from all the islands in the Windward command, and all the sta- 
tions in Jamaica, though it has never afflicted them all in any one 
year, notwithstanding the communications were not interrupted : 
— and that the removal of sick or troops from one post affected 
to another exempt from its influence, has so frequently arrested 
the epidemic, without endangering others, that removal has be- 
come the rule, isolation the exception : — The conclusion that the 
disease which decimates our troops in the West Indies is ir? its 
origin truly endemic, appears inevitable ; and further, that when- 
ever it assumes an epidemic form, it is not in any way changed 
in character, or possessed of new or adventitious qualities of 
propagating itself, however much it may differ in severity." 

The experience of the Yellow Fever epidemics of 
Spain gives the same result. Thus Velez Malaga lost by 
this scourge 3 in 7 of its inhabitants, while Cordova lost 
only 1 in 130 ; Yera lost half its population, Grenada 
only 1 in 180 ; at Carthagena de Levante 1 in 3 perished, 
at Ximena 1 in 150 ; at Malaga nearly 1 in 3 inhabitants 
died, at Ecija less than one in 10. 

The experience of such immense differences in the pre- 
valence and mortality of the same disease naturally 
suggests the inquiry whether they may not be dependent 
on some peculiar conditions of the localities themselves. 

When a careful examination is made of those districts 
which are the special seats of Yellow Fever, they are 
found to present substantially the same conditions which 
have been proved by uniform experience to be at all 
times attended with a high rate of mortality and at 
periods of uncertain but frequent recurrence, to be pecu- 
liarly subject to violent outbreaks of epidemic disease. 
These facts are altogether independent of any opinion or 
hypothesis as to the origin of such diseases. They admit 
of simple observation and comparison. 



proving the Influence of Local Conditions, Overcrowding, 41 

We have shown from the experience of every tov^^n in 
Great Britain, and of every part of every town which 
suffered most severely during the late Epidemic Cholera, 
the close and inseparable connexion between the extent 
and virulence of this pestilence and the presence of certain 
definite, physical, localizing causes ; such as overcrowding, 
filth, dampness, foul canals and ditches, w^ant of drains 
and bad drains, and want of water and foul water. In 
every country within the Yellow Fever zone, where the 
condition of towns most subject to the visitation of this 
scourge, and the particular spots in such towns most 
constantly the chosen seats of it have been examined, we 
find the same localizing conditions. 

The following statements may be cited as examples of 
the sanitary condition of Yellow Fever districts. 

Overcrowding. — Dr. Chervin informs us that in the 
Spanish towns, which are the ordinary seats of Yellow 
Fever, the first outbreak of the epidemic is constantly 
found to take place in the most densely crowded localities, 
to which spots, he says, the disease is often entirely con- 
fined ; and he cites, as examples, the outbreak of the 
epidemic of 1804 at Cordova; of 1808 at Xeres ; and 
of 1818 at Cadiz. 

The marine, military, and civil officers of Gibraltar, in 
1828, concur -in representing that garrison as far too 
densely crowded for the health of the inhabitants. 

Thus Dr. Hennen, Inspector General of Hospitals, in a 
Report to Sir George Don, says : — 

" I have minutely inspected District No. 24, in company 
with Mr. Wilson of the Civil Hospital, Mr. Woods, the medical 
officer attached to that district, and other staff officers, and it 
is with much regret I have to state to your Excellency, that in 
almost every step I took in that district I had reason for 
sui-prise, not that fever had broken out there, but that it had 
not extended farther. The pauper population is dense to a 
degree incredible, except to those who have seen it. In sheds, 
without ventilation, without drainage, and generally composed 
of the slightest materials, in tiers of beds as close as in a 
crowded transport, numerous individuals sleep." 

Dr. Broadfoot, one of the members of the Commission 
of Inquiry, says : — 

" The number of inhabitants in the town of Gibraltar would 



42 



Overcrowded state of Gibraltar in 1828. 



be too great for the space occupied by them to ensure per- 
manent health in any climate or country, even with the best 
planned streets and best constructed dwellings. Many of the 
largest buildings even, but almost all the smaller ones are 
greatly overcrowded with inmates, particularly during the 
night." 

Dr. Gillkrest says :— 

" Gibraltar is greatly overcrowded. It was not until I had 
become principal medical officer, in 1833, when I considered it 
my duty, as general superintendent of the health of the popu- 
lation, to visit all the lanes, alleys, &c., that I could have 
formed any idea of the densely-crowded and badly-ventilated 
houses of these localities, and of the difficulty of conceiving 
how such places should in general prove healthy, amongst a 
mixed population of about 1 5,000, exclusive of military, within 
the walls." 

pl Large masses of the population are necessarily crowded 
into small and ill-ventilated spaces by a peculiarity in the 
structure of the streets and courts of Gibraltar. 

" The streets," says Dr Broadfoot, " are too narrow and 
almost totally without those numerous breaks which are requi- 
site for ventilation. The majority of the dwellings, even the 
best of them, are either built in hollow squares or surrounded 
by solid walls of from 3 to 8 feet high, as if purposely contrived 
to prevent any circulation of air. * * * * 
The poorest part of the population live in dwellings of the 
above description, in the different bends and gullies of the 
rock, above the better parts of the town, and consequently 
exposed to the ascending heated air from the habitations 
below, as well as to the absolute stagnation which it seems 
does take place in these bends of the rock, frequently during 
summer." 

" A common feature of the dwellings," observes Dr. Gill- 
krest, " is that of small ' patios or square confined courts, 
entered by narrow alleys, in which the houses consist of 
several floors, each occupied by many families." 

In a despatch from the Secretary of State to the 
Governor of Gibraltar (28 July, 1829), in commenting on 
the proceedings of the Commission, Sir George Murray, 
observes : — 

" With respect to the state of the population, I should not 
have thought it necessary to repeat my sentiments upon that 
subject if 1 were satisfied that Gibraltar is not still over- 
rowded ; but I feel assured that the population continues to 



Filth a Localizing Cause of Yellow Fever. 



43 



be excessive. Upon this point I refer you to the evidence of 
Mr. White, the Collector of Revenue, who states that he found 
100 persons in a tenement which, as noted on the door plate, 
should have contained no more than 20 ; a clear proof of the 
extreme negligence of the police." 

It is not generally known that^ according to the army 
statistical reporters, " the extent of barrack accommoda- 
" tion did not, prior to the year 1827, exceed from 22 to 
"23 inches in breadth to each soldier serving in the 
" West Indies ; and as that v^^ould not admit of their 
" having bedsteads, they slept in hammocks, by vrhich 

expedient as many men could be placed in one apart- 
" ment as the breadth of their bodies would admit." The 
amount of space to each man did not much exceed 200 
cubic feet. Can we then w^onder at the frightful mor- 
tality which in those days was continually occurring 
among our troops ? 

Even at the present time the space allowed is fre- 
quently much too small for safety. The space allotted 
to the men in the garrison of St. Ann's, Barbados, re- 
ports Dr. Gavin, is in general insufficient; for example, 
in the Stone Barracks, badly constructed, placed in a low 
situation, and protected from the breeze by a plateau so 
as, in an extreme degree, to prevent aeration, only from 
539 to 543 cubic feet are allotted in the respective floors, 
while in the lower floor of the Iron Barracks there are at 
present only 506 cubic feet to each man, — scarcely more 
than one half the breathing space required to maintain the 
health and vigour of the soldier in a warm climate. 

Six, eight, or ten persons," says Dr. Milroy, speaking of the 
ordinary population of Jamaica, are often crowded at night into 
a room of eight or nine feet square. The consequences when an 
epidemic occurs, were frightfully exemplified during the late 
visitation of Cholera. At Port Maria between one-half and two- 
thirds of the inhabitants died of this pestilence in the course of 
three weeks, and an eighteenth part of the entire population was 
swept away within twenty-four hours: this was in a town popida- 
tion, and we are informed that even this mortality was very much 
below what took place on certain estates." 

Filth. — Dr. Hennen represents the state of filth of a 
considerable portion of the Gibraltar population, particu- 
larly of the beggars and paupers, as] too disgusting to be 



44 Filth a Localizing Cause of Yelloio Fever ; 



described; and Sir George Murray comments on the 
"deplorable filth" of the houses occupied by these classes. 

*' As far as the streets and exterior of the houses are con- 
cerned," observes Dr. Smith, Gibraltar is clean and beautiful, 
and without dirt ; but when we examine the interior of the houses, 
a scene of a very different nature presents itself: filth is apparent 
at every step ; the houses of the poorer classes are extremely 
dirty." 

Two successive Yellow Fever epidemics, namely, the 
epidemic of 1804, and that of 1813, broke out on the same 
spot, the dirtiest in Gibraltar, Boyd's Buildings ; and the 
epidemic of the succeeding year (1814) commenced at 
Cavallero's Buildings, " a place which competed with 
Boyd's Buildings in its state of filth." ''Whenever," 
says Mr. Amiel, "the epidemic has appeared in Gibraltar, 
it has always commenced in the filthiest spot, and this 
was the case in the late visitation." 

With reference to the Garrison of St. Ann's, Barbados, 
Dr. Linton reports, that though to the casual observer the 
quarters of the troops have the appearance of general 
cleanliness, yet there are many localities in which there 
are large collections of filth on the surface ; that the medi- 
cal officers complain that the air is frequently so offensive, 
more especially in the evenings, that they make it a point 
to keep their windows closed; that the soldiers' privy is so 
great a nuisance that it poisons the whole neighbourhood 
with its exhalations, the soil being removed every night in 
boxes and thrown into the sea ; that four hours are usually 
spent in this occupation, and the nuisance during the ope- 
ration is intolerable to all in the vicinity; that the urine 
from the barracks is carried off by an underground drain 
which empties itself near, not into, the sea, lodging its con- 
tents on the surface, and being always very offensive ; while 
there is no underground drain at all for depositing the 
contents of the officers' 7:»(9z^5 de chamhre and consequently 
their servants cannot be prevented from emptying them 
wherever they can find place and opportunity. 

Every town and village in Jamaica," reports Dr. Milroy, 
" teems with nuisances of the very worst description ; indeed there 
is scarcely a house without some "accumulation of noxious matter 
about it. On the general cleansing of the streets and dwellings, 
and the removal of filth wherever it was found, which took place 



also Want of Drains, and Bad Drains. 45 



on the threatened approach of Cholera, the remark has been made 
to me everywhere that no one had had any conception of the 
amount of abominations of all sorts which had been allowed to 
accumulate around them for a multitude of years." 

So at George Town, Demerara, during the epidemic 
from 1839 to 1846 : 

" The river Demerary," says Dr. Johnstone, and river's edge, 
or Water-street, was the focus and abiding place of the disease. 
It there abounded with fearful severity, and with scarcely an 
exception, every case tliat occurred elsewhere, could be traced to 
that impure locality. The cause of this impurity and consequent 
fixation of the epidemic influence was very apparent in the accu- 
mulation of putrescent filth and mud beneath the stellings, or long 
projecting wharves, which are thickly planted along the river's 
edge, for the reception of goods. Moreover, many of the build- 
ings in this crowded commercial mart called Water-street, are 
built on piles driven into the mud and nearly down to the low- 
water mark; and these piles serv^e most admirably for the deten- 
tion of the filth and offal from a daily vegetable market and 
slaughter-house. That this latter can be no trifling matter it 
may be observed, that here are slaughtered every morning, cattle, 
sheep, pigs, goats, &c., sufficient to supply a city with 30,000 
inhabitants, besides the surrounding country." 

Dr. Gavin confirms the correctness of this description 
by his own inspection of the locality. 

" Nothing," he says, " can to my mind be more demonstrative 
of the paramount influence of certain localizing causes in deve- 
loping Yellow Fever than the facts in relation to the late and 
present epidemics in George Town, Demerara. I had no more 
difficulty in fixing on the particular spots in George Town where 
Epidemic Fever would and did first develope itself on its return in 
1851-2, and where the force of the epidemic, fitting pabulum being 
afforded, would expend itself, than I had in indicating the localities 
in certain districts in Bethnal Green where Cholera would and did 
prove most prevalent and mortal. 

Want of Drains and Bad Drains. — Dr. McLean 
states that a committee of fifteen physicians which assem- 
bled at Barcelona during the prevalence of the severe 
Yellow Fever Epidemic of 1821, assign as one of the 
chief localizing causes of the pestilence, the state of the 
drains and sewers in the town and harbour. 

From the neglect," they say, of the public police, for many 
years previously to 1821, at Barcelona, the sewers, drains, canals^ 
and other channels for carrying off the impurities of the city, have 



46 Highly defective condition of the Drains at Gihraltar 



been choked up or become foul to such a degree, that towards the 
end of June it was impossible to pass by the sea-wall, where they 
are discharged into the harbour, without suffering from the stench 
of accumulated and putrefying animal and vegetable substances." 

All classes of witnesses concur in stating, that pre- 
viously to the outbreak of the epidemic of 1828 at 
Gibraltar, the drains, both private and public, were in a 
most defective and offensive condition. 

On referring," says Mr. Araiel, to an official statement of 
Mr. Woodward's, Surveyor of the Revenue Work?, I find that 
the drains in the lower part of the town have but little declivity, 
and receive the soil and other filth from those of the upper part, 
into which the privies of the several houses discharge their contents. 
The consequence is that, either by direct winds from the west, or 
eddy winds from the east, the foul air is blown up from the line 
wall, and in hot weather the streets and houses are filled with air 
so offensive and foetid as frequently to make the people sick. 

" The whole surface of the drains is covered with night-soil, 
which, from the want of water to carry it off, becomes m the warm 
weather an expanded ridge of putrid matter near the surface of 
the ground; and the offensive effluvia, disseminated over the 
whole place, cannot have escaped even superficial observation. 
During the late epidemic the air was particularly offensive, and 
great numbers of rats were found dead in the drains. At their 
outlets on the line-wall, and in many places where I had occasion 
to direct their opening, I always noticed that they contained a 
great deal of filth, particularly at the lower part of the town. 

" The drains belonging to the barracks, often completely 
choked, allow the corrupt substances to accumulate at the en- 
trances, and emit, during the summer months, exhalations highly 
offensive, which in several instances have been complained of by 
the men, and reported to the authorities. The drains about the 
regimental hospital open in the kitchen and in the centre of a 
small yard, forming a permanent source of poisonous exhalations. 
The first hospital servant taken ill during the late epidemic was 
the cook of the establishment, who slept in that kitchen, and the 
disease has been very severe amongst those who have been suc- 
cessively employed in the same duty. 

Malaria, produced by exhalations from common sewers, 
probably from its being more particularly the result of animal 
decomposition, appears to exert a most powerful influence over the 
character of this fever : and the truth of this fact I have had 
frequent occasion to observe while I had the medical charge of the 
Dockyard Department. In 1813 the first patient that I saw with 
the black vomit was in a gully at the south end of the South 
Pavilion, in the close vicinity of a drain, the noxiousness of which 



during the Yellow Fever Epidemic of 1828. 



47 



had been repeatedly reported to the authorities ; and I was under 
the necessity of sending to the Civil Hospital, at diiFerent periods, 
from the same neighbourhood, three gardeners, two of whom 
rapidly died of fever in that establishment. From 1819 to 1822, I 
repeatedly had under treatment at the Naval Artificers' quarters 
at Rosia, in the latter part of the summer, cases of fever attended 
by irritability of the stomach, yellowness of the skin, and other 
severe symptoms, some of which terminated fatally ; and having 
observed that a common sewer in the centre of that building was 
then in a defective state, and occasionally emitted very offensive 
effluvia, I reported the circumstances to the Commissioners of the 
Royal Navy in this garrison, as mentioned in my Annual Report 
of 1823. The drain was removed, and from that period I have 
not seen or heard of any similar attack of fever occurring in the 
establishment. During the late epidemic the first cases of fever 
in the South appear to have occurred in the neighbourhood of the 
gully near the bridge leading to the hospital, where the offensive 
vapours of a large drain were very remarkable during the summer 
months: and the disease has been especially severe in that spot, 
as in every other place deprived of a pure and free ventilation." 

Two of the Commissioners of Inquiry, Dr. Broadfoot 
and Mr. Howell, confirm these statements. Dr. Broad- 
foot says — 

" The drains were allowed to receive the sweepings of the streets 
and other solid impurities without being supplied with a sufficiency 
of water at the upper parts of them to wash away their con- 
tents." 

Mr. Howell, says, — 

That the drains emitted most foul exhalations is proved 
by evidence perfectly incontestible. I refer to the testimony 
given not merely by the medical gentlemen, but by Mr. Wood- 
ward, Surveyor of Revenue Buildings, by Lieut.-Colonel Bayley, 
by Major Middleton, by Colonel Pearson, by Captain Grawfurd, 
by Quarter- Master O' Grady, and by others; that these exha- 
lations were such as not only to pervade most houses, but uni- 
versally to corrupt the atmosphere, is proved by Major-General 
Pilkington, the Commanding Royal Engineer." 

It has been already stated that the stations where the 
disease was most concentrated and the soldiers suffered 
more severely than in any other localities, were the posts 
on the line or in the immediate neighbourhood of drains. 

In the despatch previously referred to. Sir George 
Murray calls pointed attention to the condition of the 
general drainage of the garrison. 



48 Evidence as to the state of the Gibraltar Drains. 

" I am desirous," he says, of offering some remarks and sug- 
gestions relative to the state of the public drains. All parties 
agree in opinion that the effluvia which are emitted from the drains 
are highly offensive at all times, but there is difference of opinion 
on the point whether such effluvia are injurious to the public 
health ; it being maintained by those who assert that the 
effluvia are [not] obnoxious, that some of the neighbouring towns 
of Barbary and Spain, which are unprovided with drains, are in 
general healthy. I consider this reasoning fallacious, inas- 
much as no allowance is made for the action of the air and sun 
on the exposed impurities of these towns, whereas in Gibraltar, 
as I shall presently show, those impurities remain concentrated 
in the drains, and if the late epidemic should owe in any degree 
its rise to malaria, there is abundant testimony to show that in 
the month of August last the drains were in a state to produce 
malaria in its worst condition. 

''Mr. Woodward, for instance, states that the drains in 
Southport-street, which are of great extent, and communicate 
through the Town Range Barracks up to the spot where the 
first case of the Epidemic Fever is reported to have occurred, 
had only been opened once in 14 or 15 years; and Quarter- 
Master O' Grady, of the 1 2th Regiment, after alluding to the 
continual complaints made by the soldiers of the offensive smells 
emitted from those drains, states that when they were opened 
after the fever, it had required 20 or 30 carts to carry away the 
mass of filth with which those drains were choked. 

" It may easily be conceived, therefore, that the showers of rain 
which fell towards the end of August (which the old inhabitants 
considered as the foreboding of a sickly season, and which Dr. 
Hennen noted in his Journal in the same sense) would only 
have the effect of bringing the matter collected in the drains 
into a state of fermentation, without clearing them of their con- 
tents ; and as has been stated by Major- General Pilkington, 
who had taken pains to observe the meteorological changes in 
the atmosphere, the westerly winds which prevailed in July, in 
part of August, and September of last year, blowing into the 
orifices of the drains, produced the most deleterious effluvia, and 
infected every house in the place." 

The President of the Commission, Dr. Pym, attached 
so little importance to this evidence which made so 
deep an impression on the m.inds of others that he 
states, in his Report to the Secretary of State, his con- 
viction that "neither the private nor the public drains 
" of the garrison had any share in generating the late 
" disease;" that, notwithstanding, "since it appears from 

the most respectable evidence that they were in some 



Pecuniary Loss by neglect of Sanitary Measures. 49 



places excessively offensive," it might be desirable to 
" cut off their communication with water-closets, &c, 

substituting the use of moveable receptacles of night- 

soil, as is done in Paris and other large cities that 
the population, instead of being particularly crowded, was 

supposed to be less in the year 1828 than in 1826-7;'* 
and that the salubrity of the garrison was positively main- 
tained by the westerly ivinds which in this climate are 

considered the most healthy, and which were more pre- 
" valent than usual ;" those very winds which Sir George 
Murray, on a review of the whole of the evidence, declares 
" blew into the orifices of the drains the most deleterious 

effluvia, and infected every house in the place." 

Dr. Chervin states that for some time before the out- 
break of the Yellow Fever epidemic of 1818 at Cadiz, 
" the putrid vapours emitted by the sewers which receive 
the filth and night-soil of a large portion of the population 
were so offensive as to exceed all powers of endurance 
and a physician, who visited the city in 1805, Dr. Felix 
Pascalis, observes: — 

" Someiimes in the greatest heat of summer the east, or Levant 
wind blows fifteen or twenty days without intermission, and the 
pestiferous gases from the whole lilth of the city are continually 
emitted through the air-holes of the sewers. Is there then/' he 
asks, "any need for an imported contagion to explain the gene- 
ration and spread of Yellow Fever ?" 

On an inspection of the drains of the Garrison of St. 
Ann's, Barbados, Dr. Gavin describes them as being 

for the most part loaded with deposit, and forming, in 
fact, elongated soil-pits ;" and he calls attention to the 
sum at present paid for the removal of the filthy boxes 
of ordure ; namely, 7bl. per annum, equivalent to a capital 
of 1,500/., for a small portion of which proper water- 
closets and urinals might be constructed.* 

* It has been calculated that every British soldier dyin": on a foreign 
station has previously cost the Government from 50?. to lOOZ. The total 
extraordinary civil expenditme consequent on the epidemic of 1828 in 
Gibraltar amounted to 18,500/.; add to this sum the cost of 507 men at 
the lowest estimate, and we have a loss to the country by a single epidemic 
at one station, from causes in a great measure, if not altogether preventible, 
of no less than 43,850/. And this in addition to subsequent charges on 
account of pensions, and passage money for widows and orphans to their 
native parishes. 

E 



50 Injurious effects of Dampness, Swamps, and Marshes. 



In his Quarterly Report ending the 31st March, 1848, 
Staff-surgeon Spence mentions an occasion in which he 
himself and several others suffered from the emanations 
given off by a foul drain. 

Not far from the pavilion, where I am quartered/' he says, 
there is a drain which used to be foul at all times, but which 
was not disagreeable in the quarter, because the wind seldom 
blows from the precise point, south of east, which places us to 
leeward ; but one day towards the end of January it did so, and 
so much did it oppress me individually that I observed to some 
one, * if ever bad smells should cause us to be sick, it would be 
now,' and about 28 hours after 1 had a rigor, succeeded by 
fever ; aad so in turn had every officer resident in the pavilion." 

Dampness, Swamps, and Marshes: — The influence 
of dampness in promoting the spread of Cholera is uni- 
versally admitted ; the evidence is as complete that it is 
equally powerful in localizing Yellow Fever, particularly 
the dampness arising from the foul shores of the sea ; the 
moist slime and mud on the banks of rivers, canals, pools, 
ditches, and the moats of garrisons; the mire and mud in 
the unpaved streets, lanes, alleys, and courts of towns 
and cities ; and the oozings and percolations from sewers 
and privies, which are often the cause of the humidity of 
cellar dwellings. 

Dr. Chervin states that the main causes of the 
dreadful epidemics which have ravaged Barcelona are 
the filthiness of its port and harbour, and the sluggish- 
ness and pollution of the canal " Condal," which receives 
enormous niasses of corrupt matter from manufactories, 
slaughter-houses, wash-houses, and other establishments 
situated on its banks, the latter forming a pestiferous 
accumulation of sand, mud, and filth. 

Dr. M'Lean states that the Committee of fifteen physi- 
cians of Barcelona, in 1821, concur with Dr, Chervin in 
regarding this canal as a great and constant predisposing 
cause of epidemic disease. 

'* Notwithstanding the work which wag executed some years ago 
In the bed of the Condal," they say the shallowness of the water, 
the slowness of its course, the constant action of the ardent sun 
throughout the day ; all these causes produced a stagnation of 
the impurities of the city, and rendered their discharge difficult, 
giving occasion to deleterious emanations from all points of the 
canal. 



Pernicious results of the mixture of Salt and Fresh Water. 51 



The careful examination of the Committee charged with 
cleansing tlie port has shown that this water-course was obstructed 
at its mouth by a bank of sand which, hindering its discharge, 
had occasioned a considerable collection of stinking water, the 
product of various manufactures, slaughter-houses, wash-houses, 
and other establishments situated on its banks, exhaling an in- 
sufferable stench. 

The same Coxnmittee found that the foul water, stagnant 
round this sand bank^ was one foot higher than the level of the 
sea, and more or less in other places. 

The modern works of the port have converted it into a sort of 
stagnant pool of which the cleansing has been neglected for 
several years, producing a focus of infection which had not pre- 
viously existed." 

There is a universal concurrence among the medical 
officers who are acquainted with the station; that one of 
the chief causes of the peculiar liability of the garrison of 
St. Ann's Barbados to Yellow Fever, is its low and 
marshy situation, which, according to Dr. Davy, In- 
spector-General of Hospitals : — 

" Contains, and has in its immediate vicinity, more swamps 
and lands liable to be flooded, and take on the temporary 
nature of swamps, than the whole of the rest of the island 
together, and therefore it may be truly said that, if it does not 
originate, it must be, to say the least, well calculated to foster 
the spread of zymotic diseases in every form." 

These swamps are situated at distances from the garri- 
son, varying from two miles and a half, to its immediate 
neighbourhood. The nearest to it appears to be a tidal 
swamp, receiving the pernicious mixture of salt and fresh 
water. There is no question as to the highly injurious 
nature of this admixture, but some observers regard it as 
so extremely noxious, that they attribute to this cause the 
peculiar liability of sea-port towns to epidemics in general, 
and to Yellow Fever in particular. 

"The Yellow Fever," observes Dr. A. Browne, "has so fre- 
quently ajDpeared in seaports, as to give a certain air of proba- 
bility to the assertions of those who believe that this disease 
must be always imported. Contagionists, however, as well a.** 
their opponents, have almost entirely overlooked the fact that 
such ports, generally situated near t!he embouchures of rivers, 
or on naiTow inlets having rivers ininning into theni, are more 
exposed than other places, to the causes of insalubrity,, which 
depend on the mixture of fresh with salt water. 

,E 2 



52 Modijications of Disease arising from Malaria. 



" Now this mixture of fresh with salt water is one of the con- 
ditions which is most favourable for the production of malaria, — 
probably in part from the destruction of organic life which it 
occasions, and in part from the elements which it furnishes for 
chemical reactions. The following illustration, taken from the 
report of M. Melier, will decide this point. 

" The locality of the experiment, for such it may be truly 
called, was the Maremma of Lucca on the shore of the 
Mediterranean. The ground is divided into three principal 
basins, interspersed with numerous lakes and pools, which for 
ages had been inundated from time to time by the sea, thus 
causing the mixture of fresh with salt w^ater. The insalubrity 
of this district, we are told, was so great, that ' inevitable death * 
was the consequence of passing a single night during the months 
of August and September, in this pestilential locality. In order 
to remedy this sad state of affairs, in 1740, a valved sluice was 
placed in the Burlamanca, — the channel by which the sea-w^ater 
entered the principal basin, — so constructed as to shut out the 
tides when they rose, and to allow the fresh water to escape when 
they ebbed. These works were finished in 1741. The success 
w^as so complete, that fevers which had never before failed to 
appear, ceased in the following 3'ear, and from that time the 
district became healthy. The village of Viareggio, previously 
abandoned, became an important place, and a favourite summer 
residence of the first families of Lucca. In 1768 and 1769, the 
fevers suddenly reappeared, as in their worst periods. ' What 
had happened ? Only this : the sluice had got out of repair, and 
the waters were again mixed.' The sluice was repaired, and 
fever disappeared. The deaths which had risen to 1 in 15 were 
reduced in the following year to 1 in 40 of the inhabitants. 
The same accident occurred in 1 784-5, with similar consequences, 
and the evil was remedied in the same manner. 

"Similar sluices were established at Cinquala in 1812, at 
Motrona in 1819, and at Tonfalo in 1821. Everywhere the 
success was the same ; the experiment is as conclusive as it is 
undeniable. Similar results have since been experienced at 
other places in Italy, and in France. 

" 'J'he pond of Lindre-Basse, in the department of the Meurthe, 
affords a curious illustration of the effects of the different con- 
ditions under which malaria is generated, in modifying diseases 
arising from paludal infection. This fish-pond, managed ac- 
cording to the triennial rotation system common in Sologne, is 
two years under water, and one year dry. In the first year it 
is half filled, and gives rise to intermittent fevers ; in the second 
year it is full, and typhoid fevers prevail ; in the third year, 
after being fished, it is left dry and cultivated as a field, and in 
this year carbuncular affections appear. These diseases have 
succeeded one another as regularly and invariably as the dif- 



Marsh Exhalations often confined within narrow limits. 53 

ferent states of the pond, for a period of 16 years ;* and the idea 
naturally suggests itself, that diseases which have a common 
origin, must have more or less a common nature, however much 
they may differ in outward appearance." 

Ill tracing the influence of paludal exhalations on the 
troops in Flanders during the campaign of 1748, Sir 
John Pringle states, — 

" The troops had scarcely been a month in the cantonments 
when the return of the sick amounted to 2,000, those who were 
near the marshes suffering by far the most, both in the number 
and the violence of the symptoms." 

He relates, — 

" That the Greys cantoned at Vucht (a village within a 
league of Bois-le-Duc, surrounded with meadows either then 
under water or but lately drained) were the most sickly ; that 
for the first fortnight they had no sick, but after continuing five 
weeks in that situation, they returned about 150 ; after two 
months, 260, which was about half the regiment ; and at the end 
of the campaign they had in all but thirty men who had never 
been ill. That a regiment at Nieuland, where the meadows 
had been floated all winter, and were but just drained, returned 
sometimes above half their number ; that the Scotch Fusileers at 
Dinther, though lying at a greater distance from the inundations, 
yet being quartered in a low and moist village, had above 300 
ill at one time ; while a regiment of Dragoons cantoned only 
half a league south-west of Vucht, were in a good measure 
-exempted from the distress of their neighbours. Such was the 
advantage even of that distance from the marshes, of the wind 
hlowing mostly from the dry grounds, and of a situation upon 
an open heath somewhat higher than the rest." 

Observations have been made which seem to shovi^ that 
the noxious influence of marsh exhalations is confined 
within somewhat narrow limits, or, at all events, that 
removal to short distances is often a protection from 
them. 

*' The distance," says Dr. Bancroft, " to which the exhalations 
of marshy grounds may be conveyed from their source, and 
retain the power of causing the yellow and other marsh fevers, 
will partly depend on the force of the wind, and partly on the 
extent of the surface from which they arise, and on their being 



* A change in the rotation in 1848-9 has altered the order of succession 
of these diseases. — Comptes Bendus, 1850." 



54 Marsh Exhalations sometimes carried to a considerable distance ; 

more or l^s copiously extrit^ted from that surface. If t^ 
wind be very moderate, and blow steadily from the same poini; 
and if the miasmata be abundantly emitted from a very great 
extent of surface, it seems probable that so large a mass of them 
as would thus be formed might be conveyed a quarter, and 
perhaps half a mile, before it became so diluted with atmo- 
spheric air» or so dissipated by the wind, as to lose its morbific 
power. 

" Lempriere says, that while the most disastrous consequences 
resulted from close proximity to the land, the crews of vessels 
stationed in the very narrow channel, less than a quarter of a 
mile between Beveland and Walcheren, continued healthy dur- 
ing the whole campaign." 

The La Ventille hills," says Dr. Gavin, "bound Port of 
Spain, Trinidad on the east and south. Those whites, and 
even coloured persons, who attempted to live on the southern 
side of the hills invariably die after a short time of fever, 
from the emanations of the wide spread pestilential * Carani' 
swamp which for some distance skirts the base of the hills ; 
and a military post erected near the declivity leading to the 
swamp had to be abandoned as utterly untenable. The maga- 
zine lower down is also so unhealthy as to require a constant 
and regular change of sentries. Nevertheless, on the other 
side of the hills, which are covered with wood, white persons, 
and even newly-arrived Europeans, reside with comparative 
immunity — at least from severe forms of fever.'* 

" Dr. Blane records that at Rock Fort, Jamaica, the distance 
of two cables' length was sufficient to make the difference be- 
tween great sickness and complete immunity from disease." 

As a somewhat extreme case, it is stated that the 
marsh exhalations from Brouage, when carried by the 
south-west winds, affect the inbtabitants of Rocliefort, 
distance of four or five miles. 

These statements appear to be a correct expression of 
the general fact, but there is nevertheless unquestionable 
evidence that in certain states of the atmosphere, and by 
currents of wind blowing steadily in a particular direction, 
these emanations may be w^afted to much greater dis- 
tances than four or five miles. As for instance, in British 
Guiana, where, when the land wind blows over the 
hundreds of miles of swamps in the interior, the inhabit- 
ants invariably become affected with sudden and severe 
attacks of fever. It has been long observed that when the 
atmosphere is so damp as to form visible vapour or fog, 
these pernicious emanations are carried not only in greater 



and act with yre>at virulence during Night Fogs. 55 

abundance but to greater distances than wben tbe atmo- 
sphere is dry. 

Sir John Pringle gives the following illustration of the 
intensity with which such exhalations may be accumu- 
lated in fog, and conveyed in the highest state of concen- 
tration. 

'* When the troops were in Zealand,'* he says, " they had not 
been a fortnight in the cantonments before several of the men be- 
longing to those regiments which were stationed nearest the 
marshes were seized simultaneously with lassitude and in- 
quietude, a sensation of burning heat, intense thirst, frequent 
nausea, sickness, and vomiting, aching of the bones, pain in the 
back and violent headache. There were some instances of the 
head being so suddenly and violently affected that without any 
previous complaint the men ran about in a wild manner and 
were believed to be mad, till the solution of the fit by a sweat 
and its periodic return discovered the true nature of their de- 
lirium. Most of the men were first taken ill upon their return 
from forage. The regiment being cantoned close upon the 
inundations, and many of the quarters being above two leagues 
from the place where the magazines were kept, the men were 
obliged to set out about four in the morning, in order to get 
back before the greatest heat of the day. At this early hour 
the meadows and marshes on each side of the road were covered 
with a thick fog of an offensive smell. The party generally re- 
turned before noon, but several of the men, even before they 
could get back to their quarters, were already in a violent 
fever ; some in this short space of time were actually delirious ; 
and a few on their way home were so suddenly taken with a 
frenzy as to throw themselves from their trusses into the water, 
imagining they were to swim to their quarters. One man on 
reaching home, was suddenly seized with intense headache, got 
out of his quarters, and ran about the fields like one distracted. 
Three years after this sickness it was found that two of the 
men who were thus suddenly affected with frenzy, though they 
recovered of their fever, had ever since been epileptic, and that 
all the rest who had been ill remained exceedingly liable to re- 
turns of an intermitting fever." 

Sir John Pringle observes, and the statement has 
been confirmed by subsequent experience, that a mode- 
rate elevation in a swampy district is a more dangerous 
position than a lower one. St. Ann's Fort, Barbados, is 
only about fifty feet above the level of the proximate tidal 
swamp, and offers, from its physical conformation, no 
material barrier to a sweep of air from the marsh over the 



56 General influence of local causes on outbreaks of Fever, 

fort ; and all the medical officers serving on this station are 
fully aware of the influence of this swamp in modifying 
and aggravating the epidemics with which tlie garrison 
is so often visited. 

The huts in Jamaica," reports Dr. Milroy, are placed 
on the hare ground ; there is never even a gutter provided 
to carry off the rain, which therefore soaks into the earth 
all around the wattled walls, not a little finding its way 
into the interior, independently of what penetrates the 
roof, which, if thatched, as it generally is, becomes like 
a wet sponge." 

On a review of the histories handed down of such 
epidemics as have been the subject of a particular narra- 
tive, it is found that they all contain statements of facts 
which illustrate in the most impressive manner the in- 
fluence of the localizing causes now enumerated. This 
is especially the case with the Gibraltar epidemics of 
1804, 1813, 1814, and 1828, with respect to each of 
which it appears that the spots in which the disease 
commenced and committed the greatest ravages were 
the most remarkable for their over-crowding, filth, 
dampness, and inefficient or pernicious drainage. So 
with respect to the epidemics of St. Ann's in 1805, 1816, 
1847, 1848, and 1849^ the experience is the same. Of 
the epidemic of 1805, for example, it is stated that the 
particular barrack in which the disease chiefly prevailed 
was crowded to excess ; that it was impracticable to 
ventilate the apartments on the ground floor ; that this 
ground floor was at the same time extremely damp, and 
that the men on this floor were attacked in the propor- 
tion of three to one of those in the Uj3per story. 

In the epidemic of 1816 the spot named in the record 
of the day as the ''fons mali,'' is described as having 
been in an extreme state of tilth from collections of 
ordure, mud, refuse of swine, and other putrefying 
matters, giving off the most offensive smells. Here, 
in a row of buildings called the " Huts," consisting of a 
long shed partitioned off into separate compartments, 
each compartment containing barely 1,000 cubic feet of 
space, yet lodging six persons, and consequently each 



Local cause of Yellow Fever at Galliopolis, U.S. 



57 



person having only 166 cubic feet of space to breathe in, 
the pestilence first broke out, and continued through its 
whole course to number the largest proportion of victims. 

Dr. John Davy and Dr. Collings ascribe the epidemics 
of 1847, 1848, and 1849 to an accumulation of rank 
vegetation with urinous exhalations from a neglected hol- 
low between the Artillery and Stone Barracks ; the de- 
fective drainage of the Savannah, and adjoining ground ; 
the state of the grave yard ; the breaking up of a con- 
siderable extent of ground to some depth,* and levelling 
it for the improvement of the works in the neglected 
barracks where the disease first appeared, together with 
the imperfect ventilation, and the overcrowding of the 
quarters of the men. On this occasion the disease ap- 
pears to have been confined to the garrison during the 
whole period, and for a considerable portion of that period, 
to the barracks and quarters where the drainage was the 
most defective, and the localizing causes enumerated the 
most active. 

It is not often that an epidemic is capable of being 
traced to its local source with so much precision as in 
the case of the outbreak of Yellow Fever in the army of 
the United States at Galliopolis. 

" The fever," says Major Prior, " was, I think, justly charged 
to a large pond near the cantonment. An attempt had been 
made two or three years before to fill it up, by felling a number 
of large trees that grew on and near its margin, and by covering 
the wood thus fallen with earth. This intention had not been 
fulfilled. In August the weather was extremely hot and uncom- 
monly dry ; the water had evaporated considerably, leaving a 
great quantity of muddy water, with a thick slimy mixture of 
putrefying vegetables which emitted a stench almost intolerable. 
The inhabitants of the village, principally French and very 
poor, as well as filthy in their mode of living, began to suffer 
firsts and died so rapidly that a general consternation seized the 
whole settlement. The garrison continued healthy for some 
days, and we began to console ourselves with the hope that we 
should escape altogether : we were, however, soon undeceived, 
and the reason of our exemption heretofore was soon discovered. 
The wind had blown the air arising from the pond from the 



* This breaking^ up of ground seems to have been a frequent cause of 
fever among the French troops in Algeria, and is noticed by nearly all the 
late writers on the subject. 



58 Malignant Fevers at Louisville from Stagnant Water. 



camp ; but as soon as it shifted to the reverse point, the soldiers 
began to sicken : in five days half the garrison was on the sick- 
list, and in ten, half of them were dead. They were generally 
seized with a chill, followed by headache, pains in the back and 
limbs, red eyes, constant sickness at stomach or vomiting, and 
generally just before death with a vomiting of matter like 
coffee-grounds. They were often yellow before, but almost 
always after death. The sick died generally on the seventh, 
ninth, and eleventh days, though sometimes on the fifth and on 
the third. As some decisive measures became necessary to 
save the remainder of the troops, I first thought of changing 
my quarters, but as the station was in every respect more eli- 
gible than any other, and had been made so by much labour 
and expense, I determined to try the experiment of changing 
the condition of the pond from which the disease was believed 
to have arisen. A ditch was accordingly cut ; what little water 
remained was conveyed off, and the whole surface covered with 
fresh earth. The effects of this scheme were soon obvious. 
Not a man was seized with the worst form of the fever after the 
"work was finished. And the sick were not a little benefited — 
for they generally recovered, though slowly, because the fever 
became a common remittent, or gradually assumed the inter- 
mitting form. A few cases of remitting and intermitting fever 
occurred occasionally till frost put an end to it in every form. 
As soon as the contents of the pond were changed by cutting 
the ditch, the cause, whatever it was, seems to have been rendered 
incapable of communicating the disease in its worst form. 

Professor Yandall gives an instance of the influence of 
tlie dampness connected with ponds of stagnant water in 
causing the frequent recurrence of malignant forms erf 
fever. 

Louisville, in Kentucky," he says, '^is situated on the south 
bank of the Ohio river, at the Falls, on a beautiful plain, 70 feet 
above low- water mark, stretching back and gently declining from 
the river." The rock of which the subsoil is composed " forms 
a surface remarkable for its evenness, and the soil which it pro- 
duces, as it crumbles under the action of the air, frost, and water, 
is peculiarly retentive of moisture. Ponds and slushes are abun- 
dant, wherever the black slate constitutes the surface-rock. The 
first houses erected at the Falls were built in the midst of ponds. 
Entire squares of the city are now pointed out, which occupy the 
ancient beds of ponds, large and deep enough to float a steam- 
boat. These have all been drained, and such collections of water 
are nowhere to be seen within the city limits. 

Louisville, while it stood amid its ponds, was regarded as one 
of the most sickly towns in the valley of the Mississippi. It was 



Extraordinary concentration of Fever arising from local causes. 59 

commonly called ' the grave-yard of the West.'' It is now esteemed 
one of the most healthy. Intermittent fever was a regular annual 
visitant; and occasionally a form of bilious fever prevailed, rival- 
ling yellow in malignity, and threatetiing to depopulate the town. 
The most fatal of these endemics broke out in the summer of 1822, 
after a hot rainy season. The number of victims from it, out of 
a population less than 5000, was 232. In a family consisting of 
20 persons, 19 were sick at one time, and in some families every 
individual died. At this time only one street in Louisville was 
paved, and within its limits were at least eight ponds of greater 
or less dimensions, most of which, in the course of the autumn, 
were dried up, exposing foul bottoms to the sun." 

We cite the following as an example of the extraordi- 
nary mortality which may be produced by the concentration 
of some of the more powerful of these localizing causes 
in unusual intensity. 

In the Bahamas, says Dr. A. Browne, quoting from 
the Statistical Report — 

** We find that the mortality among the white inhabitants of 
all ages was about three times as high as in Britain, while the 
mortality among the white troops there was 13 times as great 
as at home. 

" The principal barrack was, till lately, at Fort Charlotte, a 
spot notorious for its insalubrity. It is situated on the summit 
of the little ridge of ground in rear of the town of Nassau, and 
surrounded in every direction, except towards the sea, by exten- 
sive marshes, the exhalations from which, during the morn- 
ing and evening, generally envelope the barrack in a dense 
fog. 

" Shortly after it was erected, in the end of the last century, 
nearly the whole of the 47th Regiment, including men, women, 
and children, were swept off by Yellow Fever within a few 
weeks. In 1S02 the 7th Fusiliers buried 220 out of 300 within 
as short a period, and such was the virulence of the disease, 
that out of 12 officers attacked, one only recovered. In the 
following year it again broke out, and reduced the remainder 
of this force to 50 men, whose lives were for a time saved by 
removal to a neighbouring island, where only one died in the 
course of three months ; but immediately on their return, the 
commanding officer and almost every man of this ill-fated body 
fell victims to the insalubrity of the fort. For some years after- 
wards no European troops seem to have inhabited it ; but 70 
men of the 58th Regiment were sent there in 1818, who lost 
about 40 in six months, besides 13 out of 37 women and chil- 
dren ; not a man of the whole force was left fit for duty ; and 
the hves of the survivors were only saved by removal to a small 



60 Mitigation of Disease in consequence of Sanitary improvements, 

island about a mile and a half distant. The lower rooms of this 
barrack proved much more fatal to the inmates than the upper, 
and the hospital appears to have been still more unhealthy in 
its site ; so much so, that the white soldiers, in sickly seasons, 
looked upon admission into it to be equivalent to a death- 
warrant. Though the health of the black troops is, in general, 
but little affected by those febrile diseases which prove so 
inimical to the white, even that class, when occupying the same 
barrack suffered severely, particularly the men in the lower 
rooms. In 1828, out of 80 in these rooms, 17 died, or nearly 
a fifth of the whole, while out of 210 in the upper rooms, but 
8 died ; and in the new barracks at Fort Nassau only 3 died 
out of 180. 

" The barrack at Fort Nassau has always been healthy, the 
accommodation good, and the sickness and mortality among the 
troops there exceedingly low. * * These remarks, in regard 
to the barracks, have been deemed necessary, in order that 
incorrect inferences may not be drawn as to the climate of the 
Bahamas, by attributing to it a degree of mortality which seems 
to have been, in a great measure, owing to the troops having 
continued, for a long series of years, to occupy a position, which, 
form its extreme insalubrity, was not unaptly termed the abode 
of death." 

We might multiply similar instances to an indefinite 
extent, but the facts already cited suffice to show the 
connexion between the outbreak and prevalence of Yellow 
Fever and the presence of localizing causes definite, pal- 
pable, often restricted in their operation within narrow 
limits, and removable. 

So far as opportunities of observation have yet been 
afforded, the same conclusion, which recent experience has 
amply proved with respect to Cholera, is established with 
respect to Yellow Fever, that in proportion as these causes 
are removed or diminished. Yellow Fever and other epi- 
demics cease to appear in the improved localities, or recur 
at more distant intervals and in milder forms. 

Thus from official correspondence it appears that in 
consequence of the local causes of disease which were 
brought to light in the garrison of Gibraltar on the oc- 
currence of the Yellow Fever epidemic of 1828, im- 
portant measures were adopted for the improvement of 
the drainage and general cleanliness of the garrison, as 
well as for the prevention of overcrowding, and from that 



Nature of the Epidemic influence hitherto undiscovered. 61 



period up to the present time the garrison has been com- 
paratively exempt from disease. 

Similar results have of late years been experienced in 
the various towns on the Atlantic sea-board of the United 
States, since the judicious enforcement of regulations for 
the protection of the public health. 

Dr. John Davy bears, in the following words, his 
testimony to the like beneficial results of improvements 
effected under his own observation in the garrison of 
Barbados. 

" Referring to returns of sick of the troops in this continent, 
I find proof that for a series of years there has been less ten- 
dency here to the occurrence of this fatal fever (Yellow Fever), 
accompanied as it were in relation of cause and effect, with im- 
provement in the ground as to drainage in the neighbourhood 
of the barracks^ and in the provisioning of the men, and the 
avoiding of crowding them, a coincidence that will be considered, 
I hope, sufficiently encouraging to tend to further ameliorations 
with a like prospect of success. " 

" Several well marked instances/' says Dr. Milroy, "of the 
abatement or total cessation of fever by draining and clearing the 
ground in the neighbourhood of dweUings were mentioned to me 
in different parts of Jamaica. Mr. Bruce, one of the practitioners 
in the parish of Vere, quoted his own residence as a striking illus- 
tration of this fact." 

We submit that the preceding evidence establishes a 
complete identity between the localising conditions of 
Yellow Fever as they are found to exist within the Yellow 
Fever zone, and those of Cholera and other epidemic dis- 
eases over all the districts in which they prevail. 

INIedical authorities appear to be agreed that the con- 
ditions which have now been described, and the like, are 
not in a proper sense the causes of epidemic diseases, 
but rather the circumstances which determine the actual 
outbreak, spread, and intensity of such diseases when an 
epidemic influence is present. What that epidemic in- 
fluence is, constituting the true material cause of any 
prevailing epidemic, the present state of medical science 
is unable to explain. The filthiest localities, the most 
crowded quarters and dormitories, are not at all times the 
seats af those particular forms of disease called " fevers," 
though the inhabitants are generally in a depressed state 
of health. Even in epidemic seasons some such places 



62 Decomposing orgamc matter sufficient to generate Fever, 

often escape. While cities and countries in a bad sanitary 
state are sometimes devastated by pestilence, at other 
times, their sanitary state remaining unchanged, these 
same cities and countries continue free from pestilence for 
indefinite periods, the intervals occasionally numbering 
many years ; and then sometimes suddenly, but more 
frequently by slow and appreciable degrees, pestilence 
again returns and rages with its former fury. Why this 
is — why conditions which sometimes act so powerfully 
do not universally and invariably produce epidemic disease, 
is a problem yet to be solved. What is certain, however, 
and what is of the utmost practical importance is, that a 
bad sanitary condition is at all times attended with an 
excess of sickness and mortality, and that whenever epi- 
demic diseases do prevail, they concentrate their violence 
in these unhealthy localities. Still the sanitary conditions, 
as far as is apparent, remaining the same, epidemics return 
only periodically. It has been generally inferred therefore 
that for the development of that extraordinary amount of 
the same kind of disease simultaneously amongst great 
numbers of the population which constitutes an epidemic, 
there must be, besides the known conditions, the presence 
of some other condition as yet unknown ; and hence these 
known conditions are commonly said to be not gene- 
rating, but localizing causes ; the unknown or real causes 
being, in our ignorance of their true nature, compared to 
poison clouds which pass from city to city, and from 
country to country, bearing and scattering poison genns, 
the seeds of pestilence, for the development of which 
the localizing conditions that have been described afford 
the fitting and perhaps necessary nidus. 

But there is another question of great importance on 
which medical opinion appears to be less unanimous ; 
namely, the extent to which filth, overcrowding, and 
decomposing organic matter or the like, may actually 
generate fever. Though it is generally agreed that these 
causes cannot of themselves produce such epidemics as 
those in question, yet the evidence is indubitable that 
they are capable, when concentrated, of generating indi- 
vidual and even numerous cases of fever of different types, 
and of the highest degree of malignity. Sir John Pringle 
and others state,: with reference to bodies of men, that whea- 



Conditions^ favourable to the productimi of Yellow Fever. 63 

ever wounded soldiers, with malignant sores, or mortified 
limbs, were crowded together, or whenever only a few of 
such diseased persons were placed in a room with the sick 
from other diseases, for example, with those labouring under 
intermittent and remittent fevers, a severe and mortal 
typhus quickly arose ; nay, that whenever men previously 
in a state of sound health, were overcrowded in rooms 
without ventilation, typhus fever was sure to be produced. 

From indubitable facts it is argued that we see at the 
present time the actual generation of typhus in a similar 
manner, constantly going on before our eyes. One of 
the physicians of the London Fever Hospital, gives the 
tbllowing illustration of the fact : — 

A number of Irish arrive in London, and crowd tog'ether 
in the close, undrained and filthy courts in Grays Inn Lane. 
They are healthy when they arrive from the country : there 
was no fever in the neighbournood when they came. Twenty 
or thirty persons occupy a room containing barely space enough 
for the healthy existence of four. All sorts of abominations 
accumulate around these overcrowded dwellings. In a few 
days typhus breaks out. During the spring- of the present 
year, (1851) up^vards of one hundred cases of typhus have 
been received into the London Fever Hospital from courts occu- 
pying one side only of Grays Inn Lane. The disease has not 
spread to the other side of the street ; it has not extended 
even to houses in the infected courts that are in a cleaner 
and less crowded state ; the prevalence of the fever has been 
strictly limited to the houses and rooms in which the common 
localizing causes are very intense." 

That Yellow Fever may be so produced, in the climate 
of Yellow Fever, is placed by every day occurrences in 
those regions beyond the possibility of doubt. So much 
indeed is this the case, that a physician after many years 
service between the tropics, gives the following receipt 
for the sure and rapid production of Yellow Fever : — 

Take," says Dr. Bone, " of soldiers lately arrived in the 
West Indies any number ; place them in barracks in a low wet 
situation, or in the mouth of a gully, or on the brink of a dry 
river, or on the summit of a mountain, and to leeward of a 
swamp, or of uncleared ground, and where there is no water or 
only bad water ; give them each only twenty-two inches of wall 
in their barrack room ; let their barracks be built of boards or 
lath and plaster, and have neither galleries noi- jalousied win- 



64 Spontaneous outbreak of Fever on hoard the " Regalia ^ 



dows, but close window shutters, and a hole or cellar under 
the flooring for containing mud and stagnant water, and holes 
in the roof for the admission of rain, and the windows only 
eighteen inches from the floor, that they may be obliged to sleep 
in the draught of air ; and let them have drill every morning 
on wet ground, and when fasting ; guard mounting, and all 
kinds of fatigue not in the morning or evening, but during the 
hottest time of the day ; when on sentry, no shed to keep off the 
direct rays of the sun ; bad bread, putrid meat, few vegetables, 
plenty of new rum, especially in the morning ; discipline 
enforced by terror and punishment, not by mind and preven- 
tion ; an hospital similar to the barrack room, without offices, 
always crowded, plentifully supplied with rum, scantily with 
water, and so ill regulated that the men dread to enter it; a 
firm belief in the doctrine of contagion, and a horror of ap- 
proaching any person affected with Yellow Fever. Let these 
directions be attended to in Trinidad, or even in Barbados, 
and especially when the air is stagnant, or charged with nox- 
ious vapours subsequent to long drought, the soldiers will soon 
die, some of them of Yellow, some of them with Black Vomit, 
and those first, in the rooms where these directions have been 
most carefully observed." 

It is proved by melancholy experience that when due 
care is not taken to prevent the concurrence of these and 
similar conditions, individual cases of Yellow Fever, in a 
Yellow Fever climate, may be as surely produced as 
cases of typhus among the Irish in the courts of Grays 
Inn Lane and St. Giles's. Dr. Fergusson gives an in- 
stance of this, whicht may be taken as an example of a 
general rule. 

It appears that the " Regalia" transport sailed with 
black recruits from the coast of Africa for the West Indies 
in 1815 ; it is stated that the ship was good and her crew 
healthy until she took on board a large quantity of green 
wood for fuel a short time before the blacks were em- 
barked. Many of the black recruits were embarked sick 
from hospital with ulcers, fluxes, &c., and they had no 
surgeon to attend them. 

" The quantity of green wood laid in at Sierra Leone for 
fuel,'' says Dr. Fergusson, " must have been very considerable, 
for after she had been several weeks in the West Indies, there 
were still as many tons of it left as in the master's opinion would 
serve for a voyage to Europe. The ballast, too, had never been 
changed or shifted from the time she left England, nor for any 



Distinction between Local Epidemic outlrealis of Fever. 65 

discoverable time before. It was what is called sliin£:le ballast, 
small stones with a considerable mixture of mud and other im- 
purities ; and when I examined it on board the ' Eegalia,' it 
had been much fouled by leakage from the water casks. The 
ship in respect to leakage, had 32 inches of water in the well at 
the time I sounded it, and, according to the master's calculation, 
she made three-quarters of an inch every hour. A ship naviga- 
ting the tropical seas with a quantity of green wood recently 
laid in, and foul ballasting that had not been changed for years, 
and impregnated with the gases arising from putrid sea water, 
I conceive perfectly adequate to the production of the most de- 
structive fever, by furnishing morbific miasmata, similar to those 
that on land arise from marshes when exposed to the influence 
of the higher degrees of atmospheric heat." 

In a few days after sailing, Yellow Fever broke out in 
the " Regalia" with such violence that the men continued 
to fall ill one after another on the passage until all except 
one boy had been attacked, and five out of twenty-one 
died before the arrival of the vessel at Barbados ; and on 
her arrival there almost every one was seized with fever 
that came on board to supply the place of those that had 
perished. 

We submit that here is an instance of the direct and 
positive generation of Yellow Fever under circumstances 
which wuuld be commonly considered as merely furnishing 
the localizing conditions ; and consequently that there are 
known and definite circumstances which alone suffice for 
the actual production of fever. But diseases produced 
in this way, whether typhus in England or Yellow Fever 
in the West Indies, do not spread beyond, and are strictly 
confined within the boundary of the localizing conditions, 
being thus broadly distinguished from the same diseases 
when they assume an epidemic character. Every care- 
fully observed instance of the local outbreak and spread 
of fever on record, evidences the universality of this dis- 
tinction. The sequel of the history of the "Eegalia" 
affords an apt illustration of it. From authentic docu- 
ments published with the original narrative of this case, 
(see iVIedico-Chirurgical Transactions, Vol. 8, pp. 114 
and 156,) it appears that through an oversight of the 
inspecting medical officer, the ship on her arrival at Bar- 
bados, with the Yellow Fever on board, was not put 
under restraint or Quarantine ; but communicated freely 

F 



66 Spontaneous 2'>roduction of Fever in the " Donostiarra.''' 

with the sea-ports of Barbados, the Saintes, Antigua, and 
Guadaloupe ; landing the severally ill or dying subjects 
of that disease amongst the inhabitants, and at the hos- 
pitals at Barbados and Antigua, without communicating 
infection at any of these places. 

A further illustration of the same fact is afforded by 
the case of the ship "Donostiarra/' referred to by Dr. 
Gillkrest. It appears that this vessel had sailed from 
the Havannah with a clean bill of health, and after 
undergoing the usual quarantine of 10 days at Corunna, 
she touched at St. Anclero, and arrived at her destina- 
tion, the port of Passages, with a healthy crew. Her 
cargo, consisting chiefly of sugar and tobacco, had been 
discharged ; for several days many people went on board 
without any disease having broken out either amongst 
them or the crew. But first a Custom-house officer 
who had been several days on board, was taken ill, 
and died on the third day, black vomit having appeared-. 
This man was said to have been much engaged in the hold, 
looking after contraband goods. Seven days afterwards 
a man who had been in the hold, surveying the ship's tim- 
bers, likewise died. Some of the planks of one of this 
vessel's sides having been found decayed, 12 carpenters 
were employed in removing them ; six of these men 
were attacked with fever in quick succession. On the 
fourth day from the commencement of the opening of the 
ship, the disease began to appear in an unequivocal form 
on shore in the houses close to which the ship was 
moored. But it did not extend beyond the houses oppo- 
site the ship. On careful inquiry it appeared that although 
some persons were attacked whose habitations were at a 
distance, yet all so attacked had been, and had remained 
for some time within the space to which the malaria Irom^ 
the ship appears to have been limited. The names and 
occupations of those persons are given by Dr. Arrutti, the 
writer of the original account, who states that the heat at 
this time was excessive (96"" Fahr.) ; that the course of the 
wind favoured the conveyance of the noxious emanations 
from the ship to the houses ; that he ascertained each 
house in which persons were attacked, and the several 
points to which individuals labouring under the disease 
were conveyed ; and affirms, that notwithstanding the 



Cases of Yelloic Fever may a-ppear at an unusual elevation. 67 



adjuncts of " crowded, filthy, and badly ventilated habi- 
" tations, the disease did not spread ; whether they died or 
" recovered, to none out of the focus was tbe disease com- 
"municated." 

In reporting on an instance of the spontaneous pro- 
duction of Yellow Fever on board of Her Majesty's Ship 

Pilot," from December 1840 to March 1841, at Cartha- 
gena — Deputy Inspector Evans, after noticing the arrival 
of the vessel at the Dockyard of Port Royal, Jamaica, for 
the purpose of being cleaned, proceeds as follows : — 

" In attempting to perform this duty, stoves, with lighted fires, 
were put down to air the hold, as a precautionary measure ; but 
every fire a.nd light that was used was immediately extinguished 
from the foul air that had been orenerated. About three cartloads, 
or, according to some, about a punt-load of black mud, was finally 
removed from the hold, amongst which mud decayed timber in 
considerable quantity was mixed. This vessel had not been 
cleared out from the time of her arrival on this station, upwards 
of two years and some months. 

" xA.s the 17 men who were received into hospital after the 22nd 
January were attacked, when employed in the duty of removing 
the mud, it is fair to infer that they derived their illness from 
some cause on board the ' Pilot,' originating from the state of the 
hold, rather than from the marshes at Carthagena, fever not 
being prevalent in any other ship at Port Royal at the same 
lime." 

Some sporadic cases of fever, remarkable as having 
appeared at an elevation of upwards of 4,000 feet occurred 
during the autumn of 1848 in the family of a sergeant at 
Newcastle barracks, Jamaica. These cases were treated 
by Dr. M'lllree, now surgeon to the 16th Regiment, 
who speaks of yellowness of skin as one of the symptoms ; 
and on post mortem examination, he found black matter 
in the stomach of two of the subjects. 

" Its origin," says Deputy-Inspector Dr. Watson, may fairly 
be traced to the powerfully morbid agency of the exhalations 
from a cesspool, which was found to exist near the Serjeant's 
dv/elling, and perhaps to some collateral causes. 

" The cesspool alluded to had been dug about three or four 
months ago, and contained, besides the ordure which had been 
deposited in it, — ' an immense quantity of filth and soil carried 
from the privies when cleaned out ' — a very large quantity of 
water. It was situated to the windward of the Serjeant's hut, 
about 30 yards distant, and on the same level, so that the eddies 

f2 



68 Introduction of Disease hy Sick Persons improbable. 



of the north wind sweeping down the gorge of the valley doubtless 
threw the whole vokime of noxious vapours on the hut ; while 
they carried the pestiferous exhalation clear over the hut (situated 
lower down the hill) of the corporal, who, with his family, were 
quite exempt from any sickness. The serjeant had raised his hut 
with a coating of mud, six or eight inches thick, and in the neigh- 
bourhood a quantity of bush had sprung up since the rains had 
set in." 

Dr. Watson adds — 

It must be kept in mind that it (this case) distinctly and 
incontestibly proves that a fever of a malignant character and fatal 
tendency may be engendered by the agency of local causeS;, even 
on mountain stations, at an elevation generally supposed to be 
beyond the fever range ; and hence that it is a matter of policy, 
as well as of humanity, to adopt with promptitude such sanitary- 
measures as are calculated to secure the troops from the invasion 
of a disease of a like nature to that which has called forth these 
remarks." 

Such is the uniform tenor of the evidence in relation to 
these local outbreaks of disease. But if it be a fact, 
as these and similar narratives appear to place beyond 
doubt, that diseases thus generated by local causes, are 
strictly limited to the localities in which they take their 
origin and do not spread beyond tiiem — if endemic causes 
indubitably capable of generating sporadic cases, cannot 
produce an epidemic — it would seem in the highest degree 
improbable that the mere introduction of sick persons into 
a healthy community can do sp. 

For to effect this the sick must not only bring with them 
disease, but at the same time create and communicate 
those peculiar conditions, whatever they may be, on 
which the existence of epidemics depend. That such 
conditions are not ordinarily produced by the presence 
among the healthy of one sick person, or by that of a body 
of sick persons, we know, because we know that commonly 
the admission of the sick into towns previously healthy, 
and into hospitals, is followed as has been fully shown, 
by no communication of disease whatever, much less by 
the creation of an epidemic. In any alleged instance of 
this, therefore, such instance being an exception to ordinary 
experience, it is but reasonable to demand that it should be 
substantiated by such clearness and weight of evidence as is 



Necessity for International intercourse rapidly increasing. 69 



required in other cases to establish a fact antecedently im- 
probable. 

In our First Report we observed that such authorities 
as Drs. Haygartb, Fercival, Ferrier, Carmichael Smitii, 
Cuirie, Russell, Roberts, Arnott, Christison, and others, 
deny that exhalations from the living body are capable of 
permanent suspension in the atmosphere, or that they 
can be conveyed unchanged through pure air to great 
distances. They regard it as established by an indubi- 
table body of evidence, that the moment these exhiilations 
come in contact with the external atmosphere, they are 
diffused through it: that by such diffusion their injurious 
properties are destroyed, and that, though when pent up 
in close unventilated rooms or filthy ships they may 
acquire some degree of permanence, and much concen- 
tration and virulence, yet, when they once pass into the 
ocean of air, they disappear as a drop of rain in the ocean 
of water. These authorities view the property tims 
possessed by air to neutralize and destroy these exha- 
lations as a provision of nature for our well-being. 

We further observed that if the emanations thrown off 
from the living body formed permanent and powerful 
poisons like the miasma produced by decomposition, and 
if like such products they were capable of bemg conveyed 
unchanged to great distances, we should be able to live 
only in solitude ; we could never meet in society, for we 
should poison each other ; the first symptom of illness 
would be the signal for the abandonment of the sick, and 
we should be compelled by a due regard to self-preser- 
vation to \rithhold from persons afflicted with disease 
every degree of assistance that required personal attend- 
ance. 

But our physical, is in harmony with our social consti- 
tution, and not a contradiction to it. The necessity of 
intercourse between all the members of the human faniily 
is one of the final necessities of our race. The policy of 
encouraging and facilitating that intercourse among all 
the nations of the earth is one of the favourable distinctions 
of our age. The great discoveries in science, the won- 
derful iacilities which have resulted from some of them 
for personal and commercial transit and correspondence, all 



70 Alleged Importation of Yellow Fever into Grenada 



have the effect not only of connecting the remotest cities 
and towns of individual nations, but of bringing the most 
distant countries into close neighbourhood and familiar 
intercommunication with each other. But if it be true 
that plague and pestilence are capable of being imported 
from country to country, bringing devastation in their 
course, and that this calamity may be prevented, and can 
only be prevented by placing a rigid barrier between one 
nation and another, so as effectually to obstruct their inter- 
course, then there is a contradiction between the necessities 
and obligations of the human family and the physical laws 
of their being ; a contradiction in the highest degree im- 
probable, since we see it in no other part of nature, and 
which therefore ought not to be admitted as a truth, and 
much less acted on as a principle, without the clearest 
and most indubitable proof. 

We now proceed to show that there is no such proof ; 
that the alleged communication of epidemic diseases from 
one country to another rests on no sufficient evidence, 
and that when the so-called facts adduced in proof of the 
allegation are closely examined, they are found to be 
so loose, so inconsistent with admitted events, and so 
inconclusive, that they would not in a judicial or scien- 
tific inquiry be acknowledged as evidence at all. 

In the following examination we propose to include 
all the cases on which any material reliance is placed, 
not omitting one, as far as we know, which would in the 
present day be regarded as deserving consideration. 

One of the most celebrated cases of alleged importation 
is that represented by Dr. Chisholm to iiave taken place 
in the year 1793. Up to this period Dr. Chisholm admits 
that Yellow Fever, as it had hitherto existed in the West 
Indies, had always been derived from marsh miasmata, and 
was unquestionably destitute of contagion ; but he affirms 
that in that year, a nova pestis, a peculiar, original, foreign 
plague, recently generated, and utterly unknown before, 
endued with a distinct character, possessing new powers of 
devastation, and capable of propagating itself throughout 
the world, was introduced by the ship "Hankey" into 
Grenada on the 19th of February 1793 ; that from Grenada 



hy the ship Hankey*' from the Coast of Africa. 



71 



this new pestilence was propagated over not only a great 
part of the West Indies and North America, but also to 
Gibraltar, Cadiz, Malaga^ Carthagena and otlier places in 
Spain, and that in some of these places it supplanted the 
Yellow Fever properly so called. 

Dr. Chisholm's account of this extraordinary event is 
in substance as follows :— About the beginning of the 
month of April 1792 the ''Hankey " sailed from England 
in company with another ship, the " Calypso," both char- 
tered by the Sierra Leone Company, loaded with stores 
and adventurers for a projected colony at the island of 
Balama, near the mouth of the Rio Grande^ on the coast 
of Africa. During the voyage out, the crews and settlers 
of both ships were healthy, and Dr. Chisholm argues that 
there could be no reasonable ground for supposing that 
the malignant fever which after a time broke out amongst 
them was caused by marsh effluvia, because Bulama is 
surrounded by the sea, is remarkably dry, is without any 
marshy tracts, and in point of fact is the healthiest spot 
on the windward coast. But the negroes, he says, in this 
part of Africa being ferocious in an extraordinary degree, 
and said indeed to be cannibals, the settlers were preven- 
ted from erecting any sort of accommodation on shore, and 
were therefore obliged to live on board ; and the rainy 
season coming on almost immediately after their arrival, 
and the heat being at the same time excessively great, they 
endeavoured to shelter themselves from both by raising 
the sides of the ship several feet, and covering her with 
a wooden roof. 

According to the estimate of Dr. Chisholm, the settlers 
and crew, numbered in all upwards of 200 people, inclu- 
ding women and children. These persons, he says, con- 
fined in a sultry, moist atmosphere, inattentive to cleanli- 
ness, and neglecting to sweeten the ship and to destroy 
the clothes, bedding, &c., of those that died, were seized 
with a malignant fever which produced such havoc among 
them that when the time for which the " Hankey " was 
chartered had expired, there were no seamen left to navi- 
gate the ship ; and consequently they were obliged to pro- 
ceed to sea, having on board only the captain, who was 
sick, the mate, one of the settlers, {Mr, Paiba,) and two 



72 Narrative of Br, Chisholm regarding the ^' Hankey.'' 



seamen. It is stated that with much difficulty they arrived 
at St. Jago, where they found the " Charon " and " Scor- 
pion," ships of war, from each of which they received two 
men to assist them in navigating their vessel; that with 
this aid they proceeded to the West Indies — a voyage to 
England being impracticable in their stale ; and that on 
the third day after leaving St. Jago, the four men trans- 
ferred to them from the ships of Avar, were themselves seized 
with the fever, two of whom died, and the remaining two 
were put on shore at Grenada, " in the n^ost wretched 
state possible." 

Dr. Chisholm further states that Captain Bodd of the 
" Charon " having occasion about that time to come to 
Grenada, and hearing of the mischief of which the 
" Hankey" had been the cause, mentioned that several of 
the " Charon's" and Scorpion's" people were sent on board 
the " Hankey" at St. Jago to repair her rigging, &c. ; that 
from this circumstance and the communication which his 
barge's crew had with the ship, the pestilence was brought 
on board both ships ; and that of the Charon's " crew 
thirty died ; and of tlie " Scorpion's " about fifteen. 

Dr. Chisholm thus continues his narrative : — 

" The ' Hankey ' arrived at the port of St. George on the 19th 
of February. The first person who visited the ship after her 
arrival in St. George's Bay was Captain Eemington an intimate 
acquaintance of Captain Coxe, the captain of the ' Hankey.' 
This person went on board of her in the evening after she an- 
chored, and remained three days, at the end of which time he 
left St. George's and proceeded in a drogher (a coasting vessel) 
to Grenville Bay, where his ship, the 'Adventure' lay. He 
was seized with the pestilential fever on the passage, and the 
violence of the symptoms increased so rapidly as on the third 
day to put an end to his existence. The crew of the ' Defiance/ 
in Blythe Port near Newcastle, were the next who suffered by 
visiting this ship ; the mate, boatswain, and four sailors w^ent 
on board the day after her arrival ; the mate remained either 
on deck or in the cabin, but the rest went below and stayed all 
night there. All of them were immediately seized with the 
fever, and died in three days. The mate was also taken ill but 
recovered. The crew of the ship ' Baillies ' were the next who 
suffered; these communicated the infection to the ships nearest 
them, and so it gradually spread from those nearest the mouth 
of the carenage, where the ' Hankey ' for some time la}^, to 



Sickness among the Inhabitants of Grenada. 



73 



those at tlie bottom of it, not one escaping in succession whatever 
means the captains took to prevent it. 

About the middle of April the disease began to appear on 
shore. The first house it shewed itself in was that of Messrs. 
Stowewood and Co., situated close to the wharf ; and the in- 
fection was evidently introduced by a negro wench who took in 
sailor's clothes to wash, The whole of the family were succes- 
sively afflicted with it ; and by them communicated to all those 
with whom they had any intercourse. All who from friendship, 
business, or duty, communicated with the diseased were them- 
selves infected, and no instance occurred wherein the contagion 
could not be traced to its particular source. A few who sedu- 
lously avoided the houses where the infected actually were, es- 
caped. 

" That part of the garrison quartered nearest to where the 
' Hankey' lay, were the first of this class of men who received 
the infection. A barrack containing nearly one-half of the 45th 
regiment, was situated exactly to leeward of the ' Hankey' and 
distant from her about 200 yards. One of the officers visited the 
' Hankey,' and with two or three soldiers who rowed his boat, 
remained on board some time. The consequence of this 
imprudence was fatal to himself almost immediately after, and 
in a little time, to many of the men. All the officers and men 
were successively seized with the disease ; but it proved fatal 
onl}^ to recruits who had lately joined. 

" About the beginning of May the disease made its appearance 
in the detachment of Royal Artillery : a circumstance rather 
extraordinary, as that corps were quartered in a situation far 
removed from the focus of infection. It was evidently pro- 
duced, however by the communication which the gunners, doing 
duty in Fort George, had with the 45th regiment. Of 84 
people belonging to the ordnance department at that time, 
about 56 were seized with the disease before the 1st of July, 
and of these 5 died ; a trifling mortality, considering the nature 
of the complaint. All these men, however, had been about 
three years in the country, and consequently suff'ered less from 
the disease, than about 27 recruits who joined the artillery in 
July. Of 26 of these unfortunate men who were infected, 21 
died before the middle of August. 

" xAbout the 1st of June, the disease began to appear among 
the negroes of the estates in the neighbourhood of the town, 
but it did not spread much among them, nor was it marked 
with the fatality which attended it, when it appeared among 
the whites. 

" About the middle of June, the disease broke out in the 
67th regiment, and among the artificers and labourers on Rich- 
mond Hill. The infection was communicated by some of the 
latter, who had visited their friends in town labouring under 



74 Examination hy Dr. Bancroft, and others, of the 



it. All were successively seized with it ; but it fell heavier on 
the officers than the men, several of the former being young 
men lately arrived from Europe. 

" The disease in the course of the months of May, June, and 
July, appeared in several distinct and distant parts of the 
country, where the infection was carried by persons who had 
imprudently visited infected houses in town. 

" But the infection was not confined to Grenada alone ; from 
this, as a focus, it spread to the other islands ; to Jamaica, St. 
Domingo, and Philadelphia, by means of vessels on board of 
which the infection was retained by the clothes, more especially 
the woollen jackets of the deceased sailors." 

Such, are the alleged facts of tbe case as stated by its 
original promulgator. But the sudden creation of a nova 
joestis, wholly unlike the ordinary forms of disease pre- 
valent in that climate, appeared to those who were ac- 
quainted with African and West Indian Fevers, so im- 
probable that they were induced to institute an inquiry 
into the authenticity and truth of the facts thus set forth. 
In this investigation Dr. Bancroft took the lead, who 
has given in great detail the results of the inquiry, of 
which the following is a brief summary. 

First, it appeared from official returns, that the island 
of Bulama, instead of not presenting the ordinary con- 
ditions for the generation of marsh effluvia, abounds with 
extensive savannahs ; the north end of the island being one 
continued savannah, covered with long grass, and the soil 
being deep and rich. 

" Now," says Dr. Bancroft, " it is utterly impossible that 
such a soil, in such circumstances should not be greatly pro- 
ductive of morbific exhalations, in that climate, whenever by 
showers or otherwise, there is sufficient moisture for their ex- 
trication, and besides these savannahs, it is incredible that the 
shores of such an island, and especially its harbours, should not 
in a multitude of places be fitted to produce and give out marsh 
effluvia copiously : there not being, as far as I can discover, one 
situation in that part of Africa, where a ship can anchor near 
the shore, and remain even for a week in the rainy season, 
without some of her 'crew being soon after attacked by marsh 
fever." 

It was next shown, that the proceedings of the settlers 
were such as necessarily to have exposed them to the 
lull force of whatever noxious exhalations might happen 
to be present. It appears that the ''Calypso," which. 



alleqaiions of Dr. Chisliolm respecting the Hanlicy.'' 75 



after sailing with her companion for a few days, had 
"been separated from her by a storm, arrived at her 
destination fourteen days before the Hankey." It is stated 
by Captain Beaver, one of the settlers, and afterwards the 
governor of the colony, that this interval was spent by 
the settlers chiefly on shore, where they erected huts and 
tents^ wandered about where they pleased in the day, and 
returned or not as they thought proper in the evening ; 
that in short nothing could be more irregular or improper 
than their conduct, and that in this disorderly state they 
were surprised and attacked by a party of Africans, and 
lost several of their number, and that terrified at this 
disaster, they re-embarked, and before the arrival of the 
" Hankey," had already many persons on board ill of fever. 

" Those who have lived between the tropics," says Dr* 
Bancroft, " or who have read of the numerous instances of mortal 
fever produced by sleeping a single night on shore, will not be 
surprised that, after such conduct, it should have been found, 
as is mentioned by Captam Beaver, that the ' Calypso' had 
many persons ill of fever." 

The two ships having rejoined, they anchored together 
in the Bissao road, a place, says Dr. Bancroft^ where the 
coast fever is known to prevail in the rainy season, which 
had then recently begun. They remained here fourteen 
days, and during this period fever broke out in the 
" Hankey" also. Instead of referring the disease of the 

Hankey" to the same cause as that which had produced 
it in the " Calypso,'' it was conceived according to the 
received doctrine of that day, that the " Calypso" had in- 
fected the " Hankey ;" and Captain Beaver himself appears 
at first to have been of that opinion ; but there is good 

reason," says Dr, Bancroft, to believe that he did not 
" long retain this notion ; but was soon convinced from 
" personal observation that contagion had no influence in 
" spreading the fever, or occasioning the mortality which 
" resulted from it." A brief history of the two ships sub- 
sequent to this period will sufiice to show^ the credibility 
of the evidence as to importation. 

Captain Beaver gives the following account of the 
condition in which he found the Calypso," on the arrival 
of the Hankey." 



76 Proceedings of the Crew of the Haiikey" at Bulama. 



" Nothing," lie says, "was heard but mutual reproaches from the 
people of the ' Calypso.' The colonists accused the members of 
the council in the ship, of a want of attention to their comfort 
and accommodation. They were tired out with the length of 
their voyage ; irritated by the loss of their friends by the recent 
attack of the natives, and the disappointment of their hopes ; 
the major part of them had become drunken, lazy, dishonest, and 
impatient, and the setting in of the rainy season, with the 
prospect of great fatigues and privations to be undergone 
during that season, had probably contributed not a little 
thereto. In this state of mind a very considerable number of 
them resolved to abandon the colony ; and accordingly sixteen 
of them separated almost immediately ; and others, to the 
number of 147 (among Avhom were the Governor, Mr. Dalrymple 
and the Lieutenant-Governor, Mr. Young), sailed from 
Bulama in the ' Calypso' on the 19th of July, for Sierra Leone, 
and thence to London ; where they arrived in the middle of 
November, excepting about 40 who died from sickness." 

On the departure of the " Calypso," the remaining 
colonists elected Captain Beaver to be Governor, and this 
gentleman gives the following narrative of the subsequent 
course of events. 

" The first and principal undertaking of the new colonists," 
he says, was that of building a block house for their pro- 
tection and accommodation upon the summit of a hill near the 
harbour, which was then covered with a thick forest. But 
having no sort of accommodation on shore, they were constrained 
to live on board the ' Hankey' ; and the better to defend them- 
selves from the rains, they erected a covering on the ship's 
deck. Their only shelter on the island was a little tool-house, 
and as the heavy rains made it impossible to dress their victuals 
on shore, the working people were landed on the island at day- 
light every morning, and brought back on board to break- 
fast at 8 o'clock, carried back to their work at 9, brought on 
board to dine at noon ; again relanded at 2 p.m. to resume 
their labours, and finally brought on board to sleep at sunset. 
In this manner they continued to work through the rainy 
season, (which ended about the 15th of October), and afterwards 
until the beginning of November, when the ^ime being expired 
for which the ' Hankey' had been chartered, it became necessary 
to land the colonists with all their stores, to enable the ship to 
prepare for her departure, although the block-house could not 
be finished till the month of February. 

" On the 23rd of November the 'Hankey' sailed from Bulama. 
On the 26th she anchored at Bissao, and sailed thence for 
England on the 3rd of December ; but in the night of the 4th 
she grounded on a sand-bank, near the Island of Warang, 



Accounts given of the Disease by the Colonists. 



77 



which made it necessary to send a part of her crev/ in the 
pinnace (an open boat) to Bissao for assistance, and these men 
after hard rowing for two days and nights, returned with a 
schooner and a long boat, and with their help, the ship was 
again made to float ; but on this day all the people who came 
from Bissao in the pinnace were taken ill. On the 13th the 
'Hankey' was brought back to Bissao to refit; but finally 
sailed thence on the 21st of December, and anchored in St. 
Francis Bay, at St. Jago, on the 26th of that month." 

Such appears to be a faithful narrative of the events 
that befel both ships, in which it seems difficult to discover 
anything extraordinary; much less anything justifying 
the notion of the generation of a new and peculiar plague ; 
for even the excessive mortality from which the settlers 
suffered, experience proves to be but too common among 
the first adventurers to a new colony. 

Those," says Dr. Bancroft, "who were eye-witnesses of the 
disease which proved thus fatal, recognised in it nothing of Dr. 
Chisholm's nova pestis, and saw no indication of a peculiar, 
original, foreign plague, utterly unknown before I A fever of 
infection heightened to pestilential violence ! A jail fever be- 
tween the tropics !" 

On the contrary, instead of recognising anything 
peculiar and extraordinary in the disastrous fate of so 
many of his companions, Lieutenant-Governor Young, 
who was with the colonists in the " Calypso" when the 
fever first broke out at BuJama, accompanied the sur- 
vivors on their return to England, and witnessed the 
deaths that took place during the home voyage, declares 
in so many words " that this fatal fever was the coast 
" fever;" that " it was intermittent," and that ''it was 
" not infectious." 

In like manner Mr. Paiba, another of the colonists, 
also an eye-witness of the fever at its first outbreak, and 
during its whole progress, a witness to whom Dr. Chisholm 
appeals as his authority, but who positively contradicts 
some of his material statements, bears testimony to the 
same effect as Lieutenant-Governor Young, in the follow- 
ing words : — 

" Concerning the sickness which carried off the colonists, 
both at Bulama and Sierra Leone, and in the home passage of 
the ' Calypso,' it may be remarked once for all, that it was by 
no means of one kind, as the readers of Dr. Chisholm would be 



78 Nature of Evidence adduced to fvove communication of Disease 

led to suppose. Few, if any, escaped altogether ; some had 
regular intermittent fever which is the fever of the coast ; 
others had a violent fever (probably says Dr. Bancroft, marsh 
fever aggravated by accessory causes, such as being caught by 
heavy rain, drunkenness, fatiguing exercise, or labour in the 
sun, &c.) which terminated favourably or fatally in one, two, 
three, four, five or six days, or which lingered out after its 
first violence as many weeks ; some had diarrhoea and dj^sentery ; 
and others fell martyrs to the indiscreet use of opium and 
spirits as preservatives." 

These statements as to the true nature of this fatal 
fever, were confirmed in every partiealar by the inde- 
pendent evidence of Dr. Winterbottom, physician to the 
Sierra Leone Company, who was on the spot when the 

Calypso" arrived, and appears to have attended the 
sick, and who gives the following decisive testimony: — 

The fever," he says, " which carried off" so man}- of the 
settlers at Bulama precisely resembled the endemial remittent 
fever of Sierra Leone. The ' Calypso ' after leaving Bulama, 
called for refreshment at Sierra Leone, where she remained 
about six weeks, during Y>hich time upwards of forty of the 
crew and passengers died of the remittent fever, though un- 
attended with an}^ appearance of peculiar malignity." 

Dr. Bancroft observes on this clear and authorative 
evidence : — 

" Against such testimony, the unsupported assertions and 
suppositions of Dr. Chisholm, who never was on the coast of 
Africa, nor personally acquainted with any of the facts in 
question, must be of no value." 

But if the assertions of Dr. Chisholm as to the peculiar 
and extraordinary character of the fever in question were 
without any real foundation, still worse than valueless 
appears to have been the evidence he adduces with a view 
to prove the communication of this new pestilence by 
direct contact with uninfected ships and persons. 

In the narrative already quoted it will have been seen 
that Dr. Chisholm asserts in the most positive manner 
that a mortal fever was communicated by the " Hankey" to 
the " Charon" and " Scorpion " ships of war, and that the 
" Charon" lost by this pestilence thirty of her crew, and the 
" Scorpion " fifteen. 

By the publication," says Dr. Bancroft, ^' of such apparently 
decisive, though fictitious, instances and proofs of a most power- 



hy the ''Hanliey " to other Ships during her Voyage. 79 



ful and destructive contagion, on board the ' Hankey,' joined to 
others of equal value, which were stated by Dr. Chisholm to 
have occurred after her arrival at Grenada, we cannot wonder 
that many persons were so far misled as to believe in the 
generation and importation of a new and ' direfully ' contagious 
fever by that ship ; for at firstthe^ Hankey/ and not the ' Calypso,' 
was represented as the parent of this monstrous and dreadful 
production. Fortunately for the cause of truth, the falsehood 
regarding the ' Charon' and ' Scorpion' was detected, and lauda- 
bly exposed by Dr. Trotter, who happened to be then surgeon 
to the 'Vengeance,' ship of the line, one of Admiral Gardner's 
squadron, under whose protection the homeward bound West 
India summer fleet (of 1793) was then returning to England. 
He informs us at page 3*27 of the 1st vol. of his Medicina 
Nautica, that on the 22nd of August, a ship, one of the fleet, 
' lost her foremast in a squall of wind, and received other 
damage, when the admiral made the signal for the ' Vengeance' 
to take her in tow. The ship proved to be the ' Hankey ' from 
Grenada and Bulama. Captain Thompson sent carpenters 
on board with the necessary stores to assist in repairing her 
losses : they remained for three or four days, hut no sickness 
followed,' &c. Dr. Trotter afterwards mentions, how from this 
and other circumstances, he was induced to make inquiries 
concerning Dr. Chisholm's account of the consequences of the 
' Hankey's' intercourse with the ' Charon' and ' Scorpion,' par- 
ticularly from Captain Dodd, who ' had his broad pendant ' in 
the former ship, and of Mr. Smithers who was her surgeon : 
from them, says Dr. Trotter, I have copied the following narra- 
tive of their transactions with the 'Hankey,' viz., ' When the 
squadron under Commodore Dodd, came to St. Jago in 1793, 
the ' Hankey' lay there in great distress for want of hands. The 
fever was now overcome ; Mr. Smithers saw two men who had 
lately recovered. * * * The ' Charon' and ' Scorpion' sent two 
men each to assist in navigating her to the West Indies. The 
' Hankey' at this port was cleansed, washed with vinegar, and 
fumigated. No fever appeared in either of the men of war in 
consequence of this communication. They arrived at Grenada 
in perfect health,' &c. Dr. Trotter adds, ' It is probable from 
these facts, that the ' Hankey' did not import the infection that 
produced the Grenada fever. It is also doubtful how the 
eff'ects left in the ' Hankey ' could produce the fever, for the 
bedding was thrown away, and what clothing remained had 
been aired, and probably had scarcely been in contact with the 
body after being sick. Mr. Smithers was examined before the 
(lieutenant) governor of Grenada on the subject, and gave his 
opinion decidedly, that the ' Hankey' did not communicate this 
fever to the colonists.' 

" From this statement," continues Dr. Bancroft, " and other 



80 



Unhealthy state of Jamaica previous to 17^3. 



proofs, it has been unquestionably ascertained, that every part of 
Dr. Chisholm's account, which asserts the communication of any 
disease from the ' Hankey' to the ' Charon' and ' Scorpion,' was 
a mischievous falsehood, fabricated without the smallest foun- 
dation or particle of truth, since the latter ship did not lose a 
single man during her whole voyage, and the ' Charon' lost 
only four from causes described by Dr. Trotter, and wholly 
foreign to the ' Hankey.' " 

With a view to sustain the allegations of Dr. Chisholm 
respecting this alleged case of importation, Sir William 
Pym states that the health of Jamaica previously to the 
arrival of the "Hankey" was good, and in support of this 
statement quotes the authority of Dr. Hunter as to the 
salubrity of Fort Augusta and Stoney Hill. 

" On consulting Dr. Hunter's observations on the diseases 
of the army in Jamaica," says Dr. Gillkrest " we find it is 
indeed true that that writer speaks favourably of the two above- 
mentioned localities ; but they are expressly mentioned among 
exceptions, and by way of contrast with the sickly, nay deadly 
state, of other parts of the island during the period referred to. 

Thus at p. 11 , Dr. Hunter says, ' Four regiments were sent 
from England in 1780 to Jamaica ; they arrived there the 1st 
of August, and before the end of January ensuing, not quite 
six months, one-half of them nearly were dead, and a consider- 
able part of the remainder were unfit for service.' 

At p. 57, he says, ' An average of the number of sick during 
three years and a half, in which are included the convalescents, 
gives one- third of the army unfit for service at the time of the 
greatest sickness, and one -eighth at the time of the least sickness. 
The average of deaths annually upon the whole is nearly one in 
four, and of discharged men about one in eight, which, together, 
makes the loss three- eights of the whole. In less than four 
years there died in the island of Jamaica 3,500 men ; those 
that were discharged amounted to one-half of that number, 
which make in all 5,250 men lost to the service in that short 
period of time from the climate and other causes of mortality, 
without a man dying by the hands of the enemy.' 

" Speaking of the symptons of the disease, p. 64, he says, ' The 
vomiting is sometimes constant and violent, especially in the 
worst kind of the disease, and the blood being frequently in a 
dissolved state is forced into the stomach and thrown up, form- 
ing, what has been called by the Spaniards the black vomit.' 

Is it then credible," asks Dr. Gillkrest, that with this book 
before him the British Superintendent of Quarantine should 
write the following, at p. 59 of his second edition ? 

" ' These quotations, from the highest authority, prove that 



Nature of the Fever at Grenada in 1793 not peculiar. 81 



for several years before 1793 there was no instance of that species 
of disease prevailing epidemically in the West Indies, which is 
characterised by black vomiting, &c.' " 

As a contrast to Sir William Pym's account of the 
general salubrity of the West Indies, we may cite the 
description given by Dr. Fergusson on personal examina- 
tion of the island of Grenada in particular, into which the 
*' Han key" is asserted to have imported the epidemic in 
question. According to Dr. Fergusson there is no 
necessity to have recourse to the supposition of importa- 
tion, to account for the existence of Yellow Fever in this 
island, there being few places in which the endemial 
causes of this disease are more abundant. After describing 
the ridges of Eichmond Hill, Cardigan Heights, and 
Hospital Hill, " the base of which " touches upon the 
carenage, and is foul, swampy, and " most unwholesome," 
Dr. Fergusson says : — 

" The carenage itself differs little from the pestiferous creeks 
which bear that name in the West Indies. Its channel winds 
for about nine hundred yards round the bluff of Fort George so 
as to be invisible from the sea till you are actually in it, when 
it presents an oblong cul-de-sac, enclosed on every side by the 
high grounds of the Hospital and the Richmond Ridge, hanging 
directly over it. The marsh below Hospital Hill is within less 
than half a mile on the north west : the swampy margin of the 
lagoon, as it is called, (a conglobate appendage of the carenage, 
but separated from it by a reef under water,) is within a short 
distance of the south-east ; and the bowsprits of the shipping, 
even where they lie at anchor, overhang in many places the 
muddy uncleared banks of the carenage. 

" No winds but such as come in eddying gusts through the 
chasms of the hills can ever fairly sweep the surface of the 
waters at the anchorage, which from the shape of the harbour, 
derive scarcely any movement from without ; and when the 
port is crowded with vessels, obstructing all ventilation by lying 
after the manner of a carenage, as close together as they could 
be supposed to do in a dock, it is difficult to conceive, amidst 
the stagnation of the elements and combination of pestiferous 
sources, a spot more likely to generate, under a tropical sun, the 
most aggravated species of Yellow Fever." 

In further confutation of Dr. Chisholm, Dr. Stuart, 
who attended Captain Remington during his last illness, 
directly contradicts the account given of the extraordi- 
nary violence of the disease under which his patient 

G 



82 Crew of the " Hankey " suffered from ordinary Marsh Fever. 

laboured ; attributes his disease not to a mortal contagion, 
but to a cold caught on his passage ; and states that the 
symptoms, instead of justifying Dr. Chisholm's descrip- 
tion that they " increased so rapidly, as on the third day 
*^ to put an end to his existence,'' were all so very mo- 
derate, that when he left his patient at the end of three 
days, he did not even suspect danger. 

With respect to Dr. Chisholm's account of the seizure 
of the crew of the " Defiance" in Blythe Port, and of the 
crew of the ship " Baiilies," Dr. Bancroft shows that these 
statements are made without the slightest authority, and 
that they are in the highest degree improbable. 

"We have seen," he says, that the 'Calypso,' which 
is supposed by Dr. Chisholm to have infected the * Hankey,' 
and whose fever consequently must have been the same, was 
not suspected at Sierra Leone to have communicated any 
disease there, nor to have had an}^ other than a marsh fever on 
board. And we have seen that she returned thence to Eng- 
land, after suffering a mortality greater in proportion to her 
stay in Africa than that of the ' Hankey;' and it never was 
even suspected that either her crew or her surviving passengers, 
with all their bedding and effects, and those of the dead also 
(though landed and dispersed in Great Britain,) had intro- 
duced any sort of contagion, there being fortunately no person 
here to excite groundless alarms, by inventing and propagating 
falsehoods as in Grenada. In regard to the ' Hankey' we have 
every reason to believe that no other than marsh fevers or 
fevers from cold, fatigue, intemperance, and other similar 
causes, had occurred on board of her during the whole 
voyage. It appears, moreover, that she was three times cleansed 
and fumigated, viz., at Bulama, Bissao, a.nd St. Jago ; and at 
the latter of these places (at least) she must have been free 
from any contagion ; for otherwise, her unrestrained intercourse 
with the inhabitants would have excited disease in some of 
them ; which it did not, nor in any person on board the ' Cha- 
ron' or ' Scorpion,' nor in the four sailors obtained from those 
ships by Captain Coxe ; who, during the subsequent part of 
the voyage, could not have escaped it, if any had existed capa- 
ble of producing such wonderful effects as Dr. Chisholm has 
supposed in Grenada. It appears certain that everybody on 
board the ' Hankey' was well when she arrived at Grenada, 
and continued so during her stay there and also during the 
whole of her voyage to England, which is probably more than 
could be said of any other ship then at Grenada ; so that even 
if it were ascertained that an importation of febrile infection 
had then taken place^ every other ship ought to have been sus- 



Alleged importation into Martinique by the " General Elliotr 83 



pected of it before the ' Hankey,' coming, as she did, from a 
place where there is good reason to believe no contagious 
fever had ever existed." 

It is unnecessary to follow tbis strange narrative 
fartber. All tbe other statements made by Dr. Chisbolm 
appear to be equally witbout any real foundation in fact, 
and tb.e following official declaration of tbe governor of 
the colony and master of the ship is decisive of the whole 
question : — 

" The mortality," says Captain Beaver, " which took place 
in the island of Bulama, and on board the ' Hankey' after her 
departure from it, was in this country, (England,) called the 
Plague or Bulama Fever, by those who were inimical to the 
success of our enterprise ; and such serious representations were 
made on the subject, as produced an order from the privy 
council to sink that ship, though on further inquiry it was not 
carried into effect ; and the ship was restored to the owners, 
after having sustained very considerable loss,b3^ the industry with 
which certain interested people kept up the report of the 
malignity of the distemper, which it v/as said that ship brought 
home, and for which there was not the shadow of a foundation." 
* * This report (of a pestilential fever supposed to have 
been introduced by the ' Hankey,' from Bulama to Grenada^) 
was for a considerable time believed ; the ' Hankey' was sent 
to Standgate Creek to perform quarantine, and orders were given 
for sinking the ship and cargo ; however, on examination, the 
falsehood and malignity of this report being proved, this order 
was confined to the Bulama baggage only." 

We have dwelt the longer on this alleged case of 
importation, because it is the first so boldly and circum- 
stantially affirmed in modern times, because it was for a 
time extensively believed, and because it has served as a 
model for the kind of statements made in all tbe later 
reputed instances of a similar event. 

With the same confidence, as in the case of the "Han- 
key," Dr. Chisholm asserts that the "General Elliott," 
East Indiaman, imported the contagion of Yellow Fever 
into Fort Royal, Martinique, in June 1796. But in this 
instance. Dr. Chisbolm was equally unfortunate in the 
evidence which he adduces in support of the allegation, 
as in tbe case of the " Hankey." His representations and 
statements have received direct contradiction and refuta- 

G 2 



84 Alleged imjyortation into Cadiz hy the " Dolpliin.'''' 



tion b}^ Dr. Fergusson, who happened to be the surgeon 
of the General Elliott" at the time in question, and was 
on board of her in that capacity during her voyage, and 
on her arrival at Martinique. 

" This" (the General Elliot) " was one of the ships appointed 
in the spring of 1796," says Dr. Fergusson, " to take out the 
scattered remains and detachments of Admiral Christian's 
armament, that had been so severely handled by the elements 
the preceding winter. It so happened that I being then on 
my way to join the 67th regiment in Saint Domingo, was 
ordered on board of her to take charge of the detachments of 
the Buffs, 38th, and 60th, she was carrying out. J also acted 
as surgeon to the ship's crew, and can declare that when we 
landed at Martinique, there was not a single sick human being, 
except the ship's carpenter, who was far gone in consumption ; 
nor had there been the smallest illness amongst us from the day 
of our sailing at Portsmouth, except a very few of the slightest 
calentures (I had one) when we first entered the tropics, none 
of which endured more than twelve hours." 

The outbreak of Yellow Fever at Cadiz, in 1800, after 
the arrival of the ship " Dolphin," has been referred to 
as an instance of the importation of the disease. Of this 
• case Dr. Bancroft furnishes the following account : — 

" In the summer of 1800, the Government, as well as the inha- 
bitants of Cadiz, appear to have adopted the belief of an importation 
of the supposed contagion from America ; and a ship called the 
* Dolphin,' belonging to Baltimore, was generally and decidedly 
selected and accused as having been the vehicle of this mischief: 
and reports were fabricated, by which three persons were stated to 
have died of Yellow Fever on board the ' Dolphin ' during her 
passage^ and what had been supposed to be the first cases of the 
fever at Cadiz, were declared to have occurred in different indi- 
viduals, who had all directly communicated with the ' Dolphin,' 
or some of her crew : and other sailors belonging to the same 
ship were said to have found their way up the Guadalquiver, 
through St. Lucar (in which town, however, the disease did not 
appear until the middle of September), and, by lodging in the 
suburb of Triana, at Seville, to have produced the Yellow Fever 
there some days before its appearance at Cadiz. These stories, 
in point of detail and seeming accuracy, were such as Dr. Hay- 
garth, by his letter of the 23rd of May, 1799, solicited Professor 
Waterhouse to procure for him respecting the importation of 
Yellow Fever into Philadelphia, &c., and they were circulated 
generally and with great confidence, so that Don Pablo Yaliente, 
Intendant of Cuba, who had chartered the 'Dolphin' to bring 



Alleged importation by Transports into Gibraltar, 85 



himself and his family to Spain, was, notwithstanding his rank and 
connexions, arrested upon a criminal charge, tried before the 
Royal Audienza at Seville, and after a full investigation, and 
eleven months' imprisonment, fully and honourably acquitted of 
having introduced the Yellow Fever at Cadiz; and he was, pro- 
bably as a compensation for the injustice he had suffered, after- 
wards promoted by the Government. In the course of this pro- 
secution, it was juridically proved that the Yellow Fever had not 
appeared at the Havannah, whence the * Dolphin ' sailed in May, 
1800, until sometime after her departure ; and though she touched 
at Charleston on the 2nd of June, and sailed thence on the 10th 
of that month, it was (in consequence of an application from the 
Spanish Government) certified unanimously, at an extraordinary 
meeting of the Medical Society of South Carolina, on the 25th of 
April, 1801 (22 respectable physicians being present), that, 'to 
tile best of their knowledge, no Yellow Fever had existed in that 
town or in the port of Charleston prior to the 20th of June in the 
year 1800.' They also declared, on the ground of specified facts, 
their conviction that the disease in question had never been pro- 
pagated by contagion. It was also proved, and particularly by 
the testimony of Don Jose Caro, a Spanish physician, who had 
returned as a passenger on board the ' Dolphin,' and was ex- 
amined on oath by the judges at Seville, that the diseases of which 
the three sailors had died on board of that ship were not of the 
nature of Yellow Fever, but difTerent diseases, of which an ac- 
count was given. It was, moreover, proved that no symptoms of 
the Yellow Fever had appeared in any person on board the 
' Dolphin,' and consequently that the disease could not have been 
introduced by that ship ; Dr. Arejula has therefore deemed it 
proper to reject the stories concerning the ' Dolphin,' and to con- 
fess that it was impossible to ascertain whence the epidemic was 
derived." 

On no better evidence it was asserted in the like con- 
fident manner, that Yellow Fever was imported into 
Gibraltar in the year 1810, by certain vessels arriving in 
Gibraltar bay from Carthagena. 

" During the prevalence of contagious fever at Carthagena 
in 1810," says Dr. (Sir William) Pym, "four transports from 
that port anchored in the bay of Gibraltar on the 10th of 
September ; they were immediately put under the restraint of 
quarantine. On going alongside I was informed that one 
man was already dead, two were dangerously ill, and several 
others had been attacked with fever which showed itself in all 
the four transports in the course of a few days." 

Though according to this statement these transport 



86 Remarks of Dr. Bancroft and Sir JVm. Burnett on this case. 

were immediately put under the strictest quarantine, and 
continued under it during the whole time of their stay at 
Gibraltar, and though '* they were anchored," says Dr. 
(Sir William) Burnett, " at the distance of at least half 
" a mile from the garrison, and probably more," never- 
theless, Yellow Fever broke out in the garrison. 

" On the 20th of October," says Dr. Pym, " forty days after 
the arrival of the transports, in consequence, as I must suppose, 
of a breach of quarantine regulations, which, however, could not 
be detected, a Minorcan family in the south district belong- 
ing to the dockjrard, was attacked with the disease." 

In commenting on " this gratuitous supposition" of a 
breach of quarantine, Dr. Bancroft observes, If quaran- 
" tine regulations in such a case could be frustrated even 
" when enforced by Dr. Pym as their superintendent, 
*' and when he was fully convinced of the presence of a 

dangerous contagion, it certainly must be useless to 
" employ, and highly dangerous to rely upon them at any 

time." 

" On visiting this Minorcan family," continues Dr. Vjm, I 
found that the disease which we so much dreaded, actually 
existed; six out of seven persons had been attacked in one 
house, and three other families, neighbours, who had visited 
them, as also a Spanish priest," &c. 

On inquiring into the correctness of this statement, 
Dr. (Sir William) Burnett adduces conclusive evidence 
to show that the Minorcan (whose name is Jacinto Ray) 
was not the first person attacked, and that he had no 
communication with the transports from Carthagena. 

" I have proved," says Dr. Burnett, ''by the solemn declara- 
tions of J acinto Ray upon oath, and also by the concurrent testi- 
mony of Messrs. Donnet and Amiel, that this person had no com- 
munication with the transports from Carthagena, and also that 
he was not the first person attacked ; that no Spanish priest had 
attended Jacinto Ray during his illness, and consequently none 
could have received infection from this source ; that all the men 
taken ill in the barrack room of the 7th Veterans, were within 
the walls of the to^vn in a very populous part, and that the 
fever existed in the hospital of the 7th Veterans, from the 11th 
of October — that is at least nine or ten days before the occur- 
rence of Dr. Pym's first case. 

Dr. Bancroft sums up his examination of the trust- 



Alleged importation hy the " Fortune,''^ into Gibraltar. 87 

worthiness of the statements and evidence adduced by 
Sir William Pym in reference to this alleged case of the 
importation of Yellow Fever from Oarthagena into 
Gibraltar in the following words: — 

" The subsequent part of Dr. Pym's account of the progress 
of the disease has been minutely noticed and abundantly re- 
futed by Dr. Burnett, between pages 442 and 450 of his work ; 
and to them I beg to refer, because as he has anticipated every 
thing which I could offer on the subject and with some facts of 
which I had no knowledge, it becomes me to allow him the 
credit which is his due, for the ability with which he has sup- 
ported the cause of truth. * * * * Whoever will attentively 
peruse that part of Dr. Burnett's work, must I think be fully 
convinced that Dr. Pym has entirely failed in his attempt to 
make it probable, or even possible, that any imported conta- 
gion, or any other than local or atmospherical causes, should 
have produced any of the cases of fever at Gibraltar in 1810, 
or that, when produced, they manifested any contagious pro- 
perty in a single instance." 

Gibraltar has been the frequent seat of Yellow Fever 
epidemics, and on every occasion the local authorities have 
endeavoured to prove that the disease was not endemic 
but imported. With reference to the epidemic of 1813, 
for example, though the Gibraltar Board of Health attri- 
buted the sickness to local causes, the Lieut.-Governor 
published a statement that the contagion was received 
from Cadiz. The authority on which this story rests is 
chiefly that of a Spanish practitioner (Cortes), the leading 
witness (see Appendix II., p. 246) in the attempt to prove 
the importation of the subsequent epidemic of 1828 by 
the ship Dygden," hereafter to be noticed. 

The statement is, that a vessel called the Fortune " 
arrived in Gibraltar from Cadiz on the 11 th of August ; 
that one of the crew who was ill was sent to the Catholic 
Hospital, and died on the 19th of the same month ; that a 
native of Paris, who had come to Gibraltar in the same 
vessel, died on the 3rd of September ; and that from the 
3rd to the 11th of September nine persons died in the 
neighbourhood of the hospital. 

On the other hand, it is affirmed by Sir James Fel- 
lowes, the principal medical officer of the British army 
at Cadiz, that on strict inquiry he found that nothing un- 



88 Alleged importation hy the " Grand Tkrk,^^ into Barcelona. 

usual had taken place respecting fever in Cadiz before 
the 11th or 12th of September; that until the end of 
August the health of that city was excellent ; and that it 
was impossible, therefore, that the vessel in question 
could on the 11th of August have imported the disease 
from Cadiz to Gibraltar, when it did not exist in Cadiz at 
the time she sailed, nor, according to the medical state- 
ments, till more than a month afterwards. 

It was in like manner affirmed that the Yellow Fever 
epidemic at Barcelona in 1821 was imported from the Ha- 
vannah by the Grand Turk," and a great amount of mis- 
representation as to the real facts was promulgated at the 
time. On an examination of the circumstances of this case, 
it appears that when the Grand Turk " left Havannah no 
Yellow Fever was prevailing there, all the vessels having 
left with clean bills of health ; that no case of the disease 
occurred on board during her passage ; that no cases ap- 
peared at Barcelona until 33 days alter her arrival ; and 
that the disease first broke out on the 1st of August on 
board a Neapolitan polacca. which had been lying in the 
foul and pestiferous port of Barcelona during the previous 
four months. The Committee of Physicians further state, 
that during the months of February, March, April, May, 
and June preceding the arrival of the " Grand Turk," 
" there were prevalent, both in Barcelona and Barcelo- 
netta, fevers with black vomit, yellowness, and other 
alarming symptoms, such as happen sporadically more or 
less every year." 

We cannot/' they say, adopt the idea of the importation of 
the fever from the Havannah to this port, because it does not rest 
on any certain fact, nor any satisfactory reason, and because we 
have before our eyes palpable local causes which undermined the 
health of the city, and in concert with the season and certain me- 
teorological conditions, occasioned the epidemic." 

This view is confirmed by a proclamation of the muni- 
cipal authorities of Barcelona, dated the 18th January, 
1822, who state— 

'* From all the writings and medical discussions which we have 
seen up to this day, it results that the putrefaction of the waters of 
ihe port has either been the origin or has contributed notably to the 
development of a disease of painful memory to our country." 



The Banriy* at Ascemion. The " Eclair^'' at Boa Vista. 89 



In the year 1823 an opinion was advanced by Sir 
Gilbert Blane whose eminence and official position gave 
to any statement made by him the weight of authority, 
that the " Bann*' sloop of war, sailing from Sierra Leone, 
introduced Yellow Fever into the island of Ascension. 
This case was examined by Sir William Burnett, who 
published an official report upon it, from which it appears 
that Sir Gilbert Blane was m error as to the state of the 
health of the crew of the " Bann," when she left Sierra 
Leone ; that disease of precisely the same character as 
that alleged to have been imported by the " Bann " had 
existed and been prevalent in the island at former 
periods ; that after the most careful inquiry it was found 
impossible to trace the fever in question directly from the 

Bann," to any individual of the garrison of Ascension ; 
and that the first person attacked was certainly not known 
to have been in the ship, or in contact with the sick. 

The case of the "Eclair," and the history of the 
Epidemic Fever which occurred at Boa Vista in 1845, 
have been declared by high medical authority to affi)rd 
" conclusive evidence that Yellow Fever is sometimes 
imported." It will therefore be necessary to make a 
careful examination of the circumstances relative to this 
Epidemic. 

It has been affirmed, and generally credited, that un- 
usual effi)rt has been made to ascertain the facts of this case 
under circumstances more than commonly favourable to 
the discovery of the truth. Two official Reports respect- 
ing it, drawn up after personal inspection on the spot, 
have indeed been presented to Parliament — one by Dr. 
McWilliam, and the other by Dr. King; and several 
official notices of these Reports have been published ; 
but the evidence on which these two Reports were 
founded was not collected until some time after the ces- 
sation of the epidemic. The statements of witnesses, for 
the most part poor and ignorant, many of whom had 
a direct interest in establishing the importation of the 
disease by a British ship, have been admitted implicitly, 
even with respect to dates and circumstances not of recent 
occurrence, and without due examination of the credibi- 



90 



Narrative of Events ivhich bejel the '^Eclair.'" 



lity of their testimony ; and on all material points the 
reporters have arrived at directly opposite conclusions. 

On a review and comparison of the whole of the state- 
ments which have been made with respect to this case, it 
appears that the steam-ship Eclair," with a crew of 140 
ofiQcers and men, proceeded in 1844 to the coast of Africa, 
and was stationed for upwards of four months (130 days) 
at the island of Sherboro, with a view to blockade the 
eastern outlet of the passage at Shebar. This place is con- 
sidered one of the most unhealthy on the African coast ; 
vessels remaining near the island very rarely escaping an 
outbreak of Yellow Fever on board. The land is repre- 
sented as low lying, some parts being mxarshy, and the 
rest thickly wooded, and abounding in rank vegetation. 

According to the account of the surgeon of the 

Eclair," Mr. Maconchy, the ship on this occasion was 
anchored at the mouth of the river, in a position where 
she " was surrounded with filthy-looking river-water, 
urged backwards and forwards by the tides through ex- 
tensive tracts of mangrove bushes." The fresh water used 
on board was also bad, holding in solution a quantity of 
offensive vegetable matter, which produced in some of the 
crew attacks like mild cholera. The men, in parties of 
from 30 to 40, w^ere often sent up the river on boating 
expeditions, where they remained for seven or eight days 
at a time exposed, whether they slept on board or ashore, 
perhaps after a hard day's labour, to all the exciting causes 
of fever, and a tainted nocturnal atmosphere, in the rainy 
season, heavy weather having set in, and the men con- 
stantly getting as wet as possible." 

The danger of this boating service is thus stated by Dr. 
King : — 

''The duty in boats up African rivers involves considerable risk 
at any time of the yeai% but it can never be practised in the rainy 
season without endangering the health and lives of all who are 
employed, and such were evidently the sad consequences of the 
boat expeditions of the ' Eclair.' " 

The crew, according to Mr. Maconchy, in addition to 
this dangerous service, and the dreariness and monotony 
of the situation, were exposed to another depressing agency, 

from seeing the prizes of other ships passing frequently 



Her condition at Sierra Leone^ and arrival at Boa Vista. 91 

to Sierra Leone, whilst they considered themselves out of" 
the reach of such good fortune." 

Another cause was probably in operation even at this 
time, namely, the foul condition of the ship, as will here- 
after appear. 

Under these circumstances, fever broke out on board 
the ship, and proved fatal to ten of the crew ; eight of 
the ten deaths being considered by the medical officers 
as directly consequent on the boating expeditions. 
Though there were other and severe cases of sickness on 
board, these deaths appear to include the whole of the 
ship s mortality during her stay at Sherboro, a period, as 
has been stated, of above four months. 

In the month of July the Eclair " left this station, 
returned to Sierra Leone, and anchored in the harbour, 
where she appears to have remained 13 days. This hap- 
pened to be the rainy season. The crew went on shore, 
where several of them remained at night unable to reach 
the ship from being in a state of helpless intoxication. 

The consequences were soon apparent. While the 
ship remained in the harbour, fever again broke out on 
board with great violence, and continued without inter- 
mission during this and the following month. In this 
sickly state she again left Sierra Leone, proceeded north- 
ward in company with another ship, the "Albert," and 
anchored in the Gambia on the 10th of August " (one of 
the most unhealthy months at that place)," where she re- 
mained until the 15th. All this time, the fever steadily 
increasing, she arrived on the 21st of August at Boa Vista. 
She had now lost, since leaving Sherboro, 13 more of her 
crew, making in all, from the first outbreak of the disease 
at Sherboro, 37 attacks and 23 deaths ; that is, 1 in 6 of 
the crew had died. 

On anchoring in the harbour of Boa Vista, pratique 
was at once offered to her commander. Captain Estcourt, 
but he replied that he could not think of accepting it until 
he had communicated the state of his vessel to the autho- 
rities on shore. After some deliberation the Governor- 
General consented to the landing of the ship's company, 
in the hope that the formidable disease, by which so many 
had already perished, and so many others were still placed 



92 Treatment of the Crew on their arrival at the Motherhanh. 

in imminent danger, might be checked. Accordingly the 
crew, both the healthy and the sick, were sent to a Fort 
on an islet a mile distant from the town (Porto Sal Rey), 
and the officers were lodged in the town itself. This 
took place on the 31st of August. 

The hope of benefiting the crew by the change of their 
quarters from the ship to the land was not reahzed. On 
the contrary, the sickness continued to increase with so 
much virulence that, at the end of the third week after 
the arrival of the ship at Boa Vista, no fewer than 60 
fresh cases were added to the sick list, and some deaths 
took place nearly every day. 

In this state of things a consultation of the medical 
officers was held on the condition of the crew, the result of 
which was a recommendation that the ship should imme- 
diately proceed to Madeira, and if the fever received no 
check, that she should go on to England. In conformity 
with this advice, the whole of the crew, the sick as well 
as the healthy, were forthwith re-embarked, and the ship 
sailed from Boa Vista on the following day, namely, the 
13th of September. 

The sequel to this sad narrative shows that no improve- 
ment took place during the passage of the Eclair " to 
Madeira, where she was refused pratique. She therefore 
proceeded next day on her voyage to England, and an- 
chored off the Isle of Wight, at the Motherbank, on the 
28th of September, having lost, since sailing from Boa 
Vista, 12 more of her crew. Thus in the short space of 
37 days, that is, from the time when she anchored at Boa 
Vista on the 21st of August, till her arrival at the Mother- 
bank on the 28th of September, there occurred no less 
than 90 attacks and 45 deaths, including the death of 
her excellent and devoted captain. 

On her arrival in England the ship was put in quaran- 
tine, and remained under the direction of the Privy Council 
until the 31st of October. 

On the day following her arrival. Dr. Eichardson pro- 
posed that the sick should be immediately removed to a 
wing of Haslar Hospital, to be appropriated exclusively 
for them ; stating, that in his opinion, if the sick were 
placed in well-ventilated wards, with fresh bedding, and 



Character of the Fever which prevailed in the " Eclair ^ 93 

the other means of cleanliness afforded by an hospital, there 
would be no further risk to the attendants than would 
occur in wards set apart for cases of typhus fever. 

To this advice, Sir William Pym objected, and instead 
of allowing the removal of the sick, he ordered the vessel, 
with the whole of her crew^ to proceed from the Mother- 
bank to the Foul Bill Quarantine Station at Stand gate 
Creek, which place she did not reach until the afternoon 
of the 2nd of October, that is, four days after her arrival 
at the Motherbank, where they remained six days more 
before their removal into another vessel. Thus were all on 
board detained close prisoners in a pestilential atmosphere 
on the shores of their native land ; their anticipations that 
at length they should quit the scene of such terrible suffer- 
ings, and of so many horrors, their hopes of life and health, 
totally destroyed. The consequence was, that within these 
ten days, five more deaths took place, nor was it until the 
Lords of the Admiralty declared their conviction that the 
only means of preserving the lives of the survivors of the 
crew would be the entire removal of every individual from 
this ill-fated ship, that they ivere permitted to quit it. 
Their removal took place on the 8th of October, after 
which event two more deaths occurred, one of them being 
that of the pilot who took the vessel from the Mother- 
bank to Standgate Creek.* 

As already stated, official inquiries Avere directed to be 
made into the causes of this extraordinary mortality, from 
which it appears : — 

That there was nothing peculiar in the disease itself. 
The medical and other officers of the ship, as well as the 
medical and other officers at Boa Yista, that is, all com- 
petent Avitnesses who actually saw the disease, concur 
in stating that it was nothing more than an aggravated 
form of the common endemic fever of the African coast ; 
a view which is decisively confirmed by the original 

* A striking contrast to this treatment of the crew of the " Eclair " is 
exhibited in the case of Her Majesty's frigate, the " Arethusa," which re- 
cently (Feb. 14, 1852) arrived at Plymouth from Lisbon, having on board 
cases of small-pox. Instead of putting the ship in quarantine, and 
confining the healthy in the same poisonou> atmosphere with the sick, wiser 
counsels on this occasion prevailed, and more humane measures were 
adopted. On the advice of Dr. Rae, Inspector of the Royal Naval Hospital, 
the sick, twelve in number, were immediately removed to that establishment, 
and of these, two died, without any communication of the disease. 



94 Causes of Virulence of Fever in the " Eclair ^ 

description of the disease in the medical journal of th 
ship, and by post-mortem examination. 

In opposition to this generally-received opinion, how- 
ever, Sir William Pym promulgated a statement that, 
in addition to the common African fever, the celebrated 
nova pestis of Dr. Chisholm had been introduced into the 
vessel by a passenger taken on board at Sierra Leone ; 
this disease laeing, as he represents, a fever sui generis, 
known by the name of the African, Bulam, Yellow, or 
Black Vomit Fever, attacking the human frame but once, 
and differino' from the common remittent fever in bein^r 
highly contagious. 

That the doctrine on which Sir William Pym's asser- 
tion rests met with little countenance from medical 
authorities is apparent from the statement of Sir Wil- 
liam Burnett, who says : — 

" The whole of this, as regards the peculiar properties of the 
disease, called by Sir William Pym, Bulam, &c., is a gratuitous 
assumption on his part, and, in my opinion, has no foundation in 
fact; and in my view of this part of the subject I am supported 
by nineteen twentieths of the medical officers of both services, 
who are of opinion with myself that the more ardent form of 
Yellow Fever is a mere modification of the bilious remittent* so 
extensively known all over the tropical regions." 

He adds: "The fever which prevailed in the ^ Eclair,' was 
unquestionably a remittent fever, originating in marsh miasmata, 
and the exposure of the men in boats during rainy weather." 

The true yellow fever," says Mr. Watson, of Port Royal, 
Jamaica, "is, in point of fact, of rare occurrence in this place, in 
an epidemic form. Fevers make their appearance from the deadly 
black-vomit pestilence, to the innocent ephemeral paroxysm, so 
blended and shadinor oft from the most fatal to the least so, as to 
require the treatment to be equally varied. Diseases which for 
the first day or two have seemed trifling cases of common fever, 
have frequently all of a sudden assumed the most lethal aspect of 
yellow fever, and hurried their victims to the grave in a few 
hours." 

Dr. King and Dr. Stewart, in official Reports upon 
this case, state their concurrence with Sir William 
Burnett. Dr. Mc William, on the other hand, is of 
opinion that the disease, though primarily an endemic 

* In confirmation of this assertion of Sir Wra. Burnett, and in opposition 
to the statement {See p. 126), that Intermittents are unknown" in Gib- 
raltar, we subjoin the following : — 

Return 



Classification of Fevers among the Ordnance, at Gibraltar. 95 



'* Return of the Annual Nunaber of Admissions into Hospital from the Ordnance 
Military Corps stationed at Gibraltar, for Intermittent, Remittent, and Yellow Fever 
respectively, with the Average Strength of the Force in each Year, from 1S12 to 



1851 inclusive 










Years 
rs. 


^"^^A Inter- Re- 
Force °"ttent. 'mittent. 


1 

1 YelloNV. 


i 

Remarks. 

! 




1812 


804 


5 


28 




The far greater proportion of all the 


1813 


77 b 


1 


12 




fevers at Gibraltar have been returned 


1314 


750 




3 


*73 


as " simple continued fevers but 










called 


many of these approximated in 1813, 
1814, 1818, 1828,' and other years, to 










epidemic 










fever. 


Yellow Fever. 


1815 


569 




2 






1816 


610 


1 


3 


] \ 




1817 






1 






1818 


470 




• • 






1819 


453 


2 


• • 






1820 


457 


5 








1821 


451 


5 








1822 


428 


6 


2 






1823 


460 


• • 








1824 


456 


2 


3 






1825 


420 


3 


5 






1826 


403 


2 


1 






1827a 










a Returns for 1827 deficient. 


1828 


431 


8 


234& 




b Tliese fevers were all returned under the 


1829 


484 


8 






head of " Autumnal Bilious Remittent 


1830 


481 








Fevers,"' and latterly as '■ Malignant," 
being all of the prevailing epidemic. 


1831 


471 


3 






1832 


494 


6 


1 






1833 


532 










1834 


451 


o 








1835 


470 










1836 


462 










1837 


467 




• • 






1838 


439 










1839 


426 






[ \ 




1840 


477 










1841 


469 


o 








1842 


549 


3 


**2 






1843 


505 


19 


1 






1844 


495 


2 


3 






1845 


514 


1 


2 






1846 


531 


5 


1 






1847 


645 


6 




• • 




1848 


684 


13 






Very few of the cases of Intermittent 


1849 


723 


23 






Fever were indigenous ; having been 


1850 


764 


1 






mostly relapses of disease contracted 


1851 


725 








at other quarters.* 



(Signed) J. Stewart, 

Inspector General, 

Woolwich, 17 February, 1852. Ordnance Medical Department." 



* This opinion of Dr. Stewart is, no doubt, well founded ; but it is a matter of 
universal experience that the tendency to relapse in ague is much greater in countries 
where that disease originates. Moreover we learn from the Royal Engineers OfBce, 
that works requiring a very considerable removal of earth had been commenced at Gib- 
raltar during some of these years, especiallv in December 1842, and in the course of 
1848-49. See p. 57. 



96 Overcrowding at Boa Vista. Filth, — Drunkenness. 



remittent of the African coast, became, from a series of 
causes, exalted into a concentrated remittent or Yellow 
Fever, and in that manner acquired new and peculiar 
properties, not primarily and essentially belonging to it. 

With reference to this latter opinion, it may be observed 
that the Governor-General of the Cape de Verd Islands 
affirms, that not one of those who with a view to escape 
the pestilence emigrated to the different islands of the 
Archipelago, had the disease, or communicated it to 
others. According to the view of Dr. Mc William, 
therefore, this disease must have been of a very singular 
character, for in its origin at Shebar, it was not con- 
tagious, at Boa Vista it became contagious, while in the 
other islands of the Archipelago, wherever the sick or 
the uninfected fled, it again laid aside its contagious 
character, and did not spread to a single individual. 

All the inquirers and reporters agree in stating that 
among the causes which concurred in communicating to 
this disease so extraordinary a degree of prevalence and 
mortality, the more important were the following: — 

The employment of the crew uninterruptedly for an 
unusual length of time, including the sickly season, in a 
peculiarly unhealthy situation, and dangerous local duty. 

The exposure of men, whose systems were impregnated 
with the seeds of disease imbibed in this unhealthy locality, 
to the risks of unrestricted liberty on shore, in the atmo- 
sphere of Sierra Leone, during the rainy season ; one con- 
sequence of which freedom being their " inordinate indul- 
gence in ardent spirits of the worst description." 

And subsequently, at Boa Vista, the confinement of the 
crew, the sick as well as the uninfected, in a place still 
more crowded, filthy, and unventilated than their quarters 
on board, instead of their dispersion in a pure atmosphere. 

Some conception may be formed of the unfavourable 
circumstances under which the crew were placed at the 
Fort, from the account which, on personal inspection, Dr. 
King gives of its sanitary condition, who states that from 
the absence of all means of cleansing, from the actual 
accumulation of filth, and from the impossibility under 
any circumstances of obtaining a free circulation of pure 
air, owing to the plan of the building, the atmosphere 
which the sick, the convalescent, and the healthy were 



Poison generated on board the " Eclair " herself. 97 



compelled to breathe, day and night, must have been 
polluted and deleterious in the extreme ; and that into a 
space incapable of affording sufficient accommodation for 
50 men, upwards of 100, including the sick, were huddled 
together under a most oppressive heat, the thermometer 
ranging from 8P to 86°. This description is confirmed 
by the testimony of Dr. Almeida, who states that having 
been requested by the Governor-General to go to the 
Fort and see the sick, " he found them so extremely 
crowded that he could hardly pass between them." 

The influence of such conditions in conducing to the 
virulence and spread of the disease has been already 
exeuiplitied in what has been stated under the head 
" Localizing Causes ;" but it must be added, that the 
crew had here also access to ardent spirits, in which both 
the sick and the uninfected indulged to still greater 
excess even than at Sierra Leone. 

" It is with great regret," says Sir William Burnett, I have 
now to state on the best information, that while in this situation 
means were found to supply the sick as well as others with enor- 
mous quantities of ardent spirits, which were drunk with avidity 
and produced the most deleterious effects ; indeed I have reason 
to believe that some were absolutely killed by it as if by poison. 
Had there not been a fever already in existence, the intense lieat 
(86^ of Fahrenheit), the nature of the soif and this dreadful 
intoxication together, would have been fully sufficient to have pro- 
duced it, and one of the worst kind too, in which irritability of 
the stomach and dark-coloured vomiting would have beeri con- 
spicuous symptoms." 

The actual result, as stated by Dr. ]M' William, w^as 
that the accession to the sick-list and the mortality became 
much greater at this time than they had been at any pre- 
vious period, and that from an endemic remittent of the 
African coast, the disease became exalted into a concen- 
trated remittent or Yellow Fever. 

Indubitable evidence further shows that, in addition to 
all these causes of disease, the crew when on board were 
constantly inhaling a poison generated in the ship itself. 
On a superficial examination the ship may have appeared 
clean, and Sir William Pym positively asserts that she 
was so ; but there is conclusive evidence that this appear- 
ance was fallacious. 

H 



98 



Green Wood taken on hoard at Sierra Leone. 



From the records of the Medical Department of the 
Navy we have extracted tlie foUoAving decisive statement 
v/ith reference to this point, by Captain Simpson, late of 
the Rolla :"— 

" In June, 1845, being then in command of the ' Rolla,' I went 
on board the ' Eclair ' off Shebar River. Commander Estcourt 
reported to me that he had sent a boat up the Sherborough 
River, and that the crew, during night, were exposed to heavy 
rain and much lightning, and were sick : some deaths had 
occurred on board. In the early part of July I went to Sierra 
Leone for supplies ; the ' Eclair ' was there ; the vessel was 
anchored close to the shore ; and I advised her Commander to 
move her further out, which he did. There seemed much 
excitement amongst the crew ; some liberty had been given 
them, and drunkenness and sickness were the consequence, 
y^ood was received on board for fuel in lieu of coals. This 
wood was green, as I understood at Sierra Leone, and very 
unhealthy to burn." 

This fact is substantiated by the log of the '^Eclair," 
which shews that from July 16th to the 19th inclusive, 
the crew were employed at Sierra Leone in w^ooding. 

The influence of a quantity of green wood recently taken 
on board a siiip navigating the tropical seas, in producing 
destructive fever, is shown in the most striking manner 
by the history of the " Regalia," already given (page 64), 
and by that of the ^'Yestal" (Appendix HI., page 299). 

Further evidence will be found in the Medical Depart- 
ment of the Navy to show that the hold of the ' Eclair ' 
was in a pestiferous state ;" and Dr. King states, that long 
after the people left the ship in England, and when the 
engines were removed, mud, some inches deep, was found 
under the flooring. 

" I should scarcely have noticed the above circumstance," he 
says, but for some remarkable occurrences which took place in 
the same vessel at a subsequent period, which confirmed me in the 
•jpiiiion 1 had previously formed that the origin and continuance 
of the fever on board depended solely on local causes. 

The 'Kosamond,' formerly the ' Eclair,' was commissioned 
at Woolwich on the 5th of November, 1846^ for the Cape of Good 
Hope station, but none of the former crew rejoined the ship. 
Daring the time of fitting out, four cases of typhus fever occurred^ 
and were sent to the hospital, where two of them died, but it is 
necessary to mention that typhus was prevalent at Woohvich at 
the time. The steamer left England for the Cape on the 23rd of 



Fever on hoard the " Rosamond,^' formerly the " Eclair.^' 99 



February, 1S47. Three days after sailing, one of the men was 
affected with slight febrile syniptoms, and he continued more or 
less indisposed for a number of days, but occasionally felt so well 
that he returned to his work. After the ship entered the tropics^ 
however, the disease began to assume a new and alarming 
character; and when otF the Island of St. Nicholas, and almost in 
sight of Boa Vista, the man died, having had for two days pre- 
vious black vomit and other characteristic symptoms of Yellow 
Fever. Within a few days afterwards the ' Rosamond' arrived at 
Ascension, where I was then stationed ; and Commander Foot 
having communicated to Captain Hutton, the superintendent of 
the island, every particular respecting the illness and death of the 
seaman, 1 was ordered with Dr. Sloane, the surgeon of the hospital, 
to make a report on the case, and at the same time to suggest 
measures for the benefit of the shipwirhout endangering the health 
of the people on the island. Having obtained from Dr. Slight, 
surgeon of the ' Rosamond,' every information relative to his late 
patient, we stated our opinion that the disease the man died from 
was sporadic Yellow Fever. * » * On the followino^ morning 
I went on board with the view of learning^ somethingr to enable 
me to form an opinion as to the sanitary condition of the ship, and 
for the purpose also of inspecting the sick, as the surgeon informed 
me he had then a suspicious case, with symptoms of a low kind of 
fever. I had barely time to take a cursory view of the after parts 
of the ship, when my attention was called to the patients, who 
were all mustered in the steerage, and I found the man the doctor 
had alluded to in such a precarious state that I recommended him 
to be sent on shore immediately. The only other severe case was 
that of a supernumary lad, who was taken ill the same morning, 
but the indications of a low malignant fever were so apparent even 
at that early stage, as to induce me to express my opinion to the 
surgeon that he would not probably survive 24 hours. As it was 
most desirable to prevent a panic among the ship's company, I 
went on shore to consult with Captain Hutton, and make arrange- 
ments for their reception. * * * ^ The patients themselves 
attributed their illness to foul air in the forepart of the ship ; one 
of them said he suffered so much from an abominable stench in 
the boatswain's store-room, that he represented the circumstance 
and obtained permission to cut a hole in the floor, which exposed 
to view a considerable quantity of soft mud, and five or six buckets 
full of it mixed with decayed shavings, and emitting an offensive 
odour, were removed at the time. 

" It appears then, that besides an unusual number sleeping in the 
fore-cockpit, some of them at least had been exposed to a morbific 
miasma, exhaled from a festering mass of filth in the bottom of 
that part of the ship. The quantity of mud, no doubt, was small 
in comparison with what had accumulated when the vessel arrived 
at Spithead from the coast of Africa, yet the malaria eUminated 



100 Alleged communication of Fever to Boa Vista. 



from that small and circumscribed focus was equally virulent in 
its operation, and produced the same disease in a few who were 
placed within the sphere of its influence." 

Such is a brief narrative of the circumstances connected 
with this ship and her crew. 

But it has been alleged that while the landing of the 
crew of the " Eclair," at Boa Vista, afforded no benefit 
to the ship's company, it inflicted a grievous evil on the 
inhabitants of the island ; that several individuals in 
contact, or close proximity with the sick, became affected 
with the same kind of fever ; that from these individuals 
the malady spread to others with whom they came in 
contact, and from these again to others, as from so many 
centres of contagion, until the disease became general 
over the island, thus affording a positive instance of the 
importation of epidemic disease. The alleged facts on 
which these representations rest are the following : — 

It is stated, that during the occupancy of the Fort by 
the crew, there was a small Portuguese guard stationed 
there ; that this guard was several times relieved ; that 
at the time when the " Eclair " left the island, the guard 
consisted of one negro and two European soldiers ; that 
within three days after the sailing of the " Eclair," both 
Europeans were attacked with fever similar to that from 
which the crew of the Eclair" had suffered ; that the 
negro soldier, who, with his comrade — the man sent 
from Boa Vista to nurse the two Europeans — on return- 
ing from the small island to Porto Sal Rey, had been — " as 
a matter of precaution" — " restricted for [' about 8 ' or] 17 
days to the occupation of a small hut at the northern 
end " of the town, was afterwards attacked, — though not 
confined to bed until the day following his return to 
barracks ; and that a woman (Anna Gallinha), who lived 
next door to this hut, was the first person who was 
attacked with fever in the town. It is further stated that 
a man (Pathi), who had been a labourer on board the 
''Eclair," was also attacked with fever, according to one 
account^ on the day after the ''Eclair" sailed; but 
according to another account, on the third day after that 
event. 

Such are the alleged facts, and the only ones bearing 



Examination of Evidence in support of the Allegation. 101 



directly on tlie communication of a specific contagion by 
the crew of the " Eclair/' collected by Dr. M' William by 
personal inquiries on the spot ; and these, in his opinion, 
present a chain of evidence sufficient to establish a positive 
instance of the importation of epidemic disease. 

With reference, however, to these inquiries, it has been 
already stated that they were not instituted until several 
months after the departure of the " Eclair " from Boa 
Vista; — the only regular practitioner on the island 
(Dr. Kenny) who could have given authentic and trust- 
worthy information respecting the nature and progress 
of the disease, had died ; — the witnesses examined by 
Dr. M'William, poor and ignorant, gave their evidence, 
hearsay and otherwise, in the loosest possible manner ; 
— ^their statements as to dates and occurrences, alleged 
to have happened several months before the inquiry 
took place, were received implicitly, without examination 
into the correctness of their answers and the credibility 
of their testimony ; — all the \\ itnesses of this class 
appear to have spoken under the influence of the strongest 
feeling of self interest with a view to establish a claim 
to pecuniary compensation should they be able to make 
out a case against the " Eclair," in which expectation 
they were not disappointed, since the sum of 1000/. was 
eventually granted by Great Britain for the benefit of the 
inhabitants ; — and to this motive may probably be ascribed 
the highly coloured and exaggerated statements put forth 
by these people on the reappearance of fever in the fol- 
lowing year. 

Taking the facts, however, precisely as they are repre- 
sented in the Report of Dr. M 'William, we submit that 
they do not, as the proof of the allegation in question re- 
quires, present a clear and palpable chain of evidence, con- 
necting as cause and effect the fever of the ship with the 
epidemic on shore ; but on the contrary, that there is not 
a single link undoubtedly connecting the one with the 
other. 

Take the first case forming what is represented as 
the first link in this presumed chain, the seizure with 
fever of the two guards at the Fort.* Two European 



* See Note, Appendix III., p. 309. 



102 Examination of Evidence for the alleged Lnportation. 



soldiers lately arrived in the colony, and therefore pecu- 
liarly predisposed to an attack of endemic fever, go from 
Boa Vista, which at tliat time was healthy, to a confined, 
imventilated, overcrowded, and filthy spot on another 
island where fever was raging to such a degree that 
within the space of three weeks there had occurred no less 
than 60 attacks and 33 deaths, in a crew consisting on the 
arrival of the ship of 117 officers and men. We submit 
that there is in this no evidence of the propagation of 
disease by a specific contagion ; on the contrary, it is the 
ordinary production of disease by its ordinary cause, 
namely, exposure to a polluted atmosphere, the pollution 
being, in this instance, excessive from overcrowding ; from 
accumulation of filth ; from foul and offensive privies ; from 
the impossibility of the admission of fresh air, owing to 
the construction of the building, and from the intense and 
oppressive heat, the thermometer ranging from 81° to 
of Fahrenheit. The seizure of two men with fever under 
such circumstances is precisely analogous to the case to 
which we have so often directed attention — the attack of 
persons^ previously health}^, with typhus, who take up 
their abode in the crowded and fiUhy courts and alleys 
of English towns. 

Take the next link in the chain, the attack of the negro 
soldier. The circumstances respecting this man, being 
precisely the same as those relating to tlje two other guards, 
the same answer would have sufficed for both, but we may 
observe further, that according to the testimony of the man 
himself, his illness was very slight, and his companion who 
was sent to lodge with him at the hut in Porto Sal Rey, had 
no illness at all during the whole time of their seclusion. 

The third link in the chain is the presumed fact, that a 
w^oman (Anna Gailinha), who lived next door to the hut 
in which these two men had been confined, was seized 
with fever soon after they had left it, and that she was 
the first person attacked, at least whose illness attracted 
public attention, in the town of Porto Sal Rey. Dr. King 
states, that on a personal examination of the soldier who 
had experienced the slight attack of fever, he said that 
during the seventeen days that he and his companion 
were confined to the hut, " they had no communication 



Local Causes existing in the Island of Boa Vista. 103 



with an}^ one/' Dr. M'William, on the other band, aSirms 
that Gallinha was a frequent visitor at the hut, and, 
indeed, cooked for the men. Supposing Dr. MWilliam's 
account to be the correct one, it is surely more reasonable 
to attribute the attack of Galli-olva to the local causes to 
which she vv^as exposed, and which Dr. M William 
admits were sufficient to account for her illness, than to 
contagion derived from a man whose illness was so 
slight that it had not confined him to his bed for a single 
day, and which was incapable of infecting his companion 
who was constantly with him night and day, 

" By the time Anna Gallinha was taken ill," says Dr. M'Wil- 
liam, mncli rain had fallen ; the weather had become more hot^ 
and, in short, there now (but not before this) existed the recog- 
nized elements for malarious evolution." 

*' In that part of the town called Beira, or Pao de Varella," re- 
ports Dr. King, "where Anna Gallinha and the soldiers resided, 
4lie houses are of the lowest description, and the people who 
occupy them are generally very poor and destitute ; there is a 
large pool of stagnant salt and fresh Avater immediately behind ; 
but to windward of this part of the town, and still nearer to 
the houses, there is a locality which is resorted to by man}^ of 
the people w^hen obeying the calls of nature ; and the exhalations 
from the one, and the effluvia from the other, are blown by the 
north winds in the direction of Beira." 

A similar description of this locality is £:iven by Dr. 
M'William,— 

" In the upper portion of the town," he says, " which is called 
Pao de Varella, the houses are in general mere hovels, rudely 
built and much crowded together, and with few exceptions dirty. 
They are occupied by the lowest classes. From the total absence 
of any police laws the streets here are also very filthy." 

Here then were present in full force, as is admitted, 
the ordinary localizing causes of fever ; to which, we 
submit, it is more consistent to refer this case, than to an 
extraordinary and foreign cause. 

But at this point the presumed chain of evidence stops , 
the chain is suddenly snapped; there is no further link 
traceable ; there is nothing really connecting the illness of 
Gallinha with the next cases, or with the general spread 
of the disease which rapidly followed, and we need hardly 
state, that in order to prove the spread of a pestilence 
by contagion, communication, either direct or indirect. 



104 Failure of evidence in support of Contagion from the " Eclair." 

must be proved to have existed between all the persons at- 
tacked.* 

For the onlj^ other case of fever that is stated to have 
occurred shortly after the sailing of the "Eclair," namely, 
that of the labourer (Pathi) who had been employed on 
board the ship, will scarcely be considered as affording an 
additional link ; since admitting that this man contracted 
his fever while employed on board the " Eclair," iiis case 
would be merely one of infection from going on board a 
foul ship, a generally recognized cause of fever. — 

" Whenever," says Dr. Stewart, " fever has prevailed much 
in ships on the West India and African stations, strangers going 
on board of those ships have been particularly liable to its 
attack ; but on sending fever cases from those ships to the 
hospitals and private houses on shore, it has not been found 
that the disease extended from them." 

But as in the locality of the dwelling of Gallinha, so in 
the district in which this man lived, there were local causes 
abundantly sufficient to account for the endemic origin 
of his disease. He resided in Rabil, one of the hamlets 
in the neighbourhood of Moradinha, at some distance 
from Porto Sal Rey. Of this locality Dr, Kiiig says : — 

" If there is one spot more than another in the whole island 
where, from its physical peculiarities, endemic fever might be 
expected to begin first, and end last, that locality is Moradinha, 
and the villages in its vicinity, in one of which Pathi resided." 

It may he observed further that whatever may have 
ben the cause of this man s fever, it is admitted, that 
for three weeks at least it was communicated to no one 
else in the house at Moradinha, where he was attacked, 
and remained for eight days, and not to any one else in 
that neighbourhood for 11 weeks; that his illness was 
extremely slight, and that on his return to his own house 
no disease broke out for some time in his family. Accord- 
ing to Dr. M' William, the first member of his family 
that was attacked was one of his children, who was 
taken ill on the tenth or eleventh day" after his return, 

* The widow of the next victim (Affonso) denied his having had communi- 
cation with Gallinha ; and Dr. Almeida " found about 20 people sick " in Porto 
Sal Hey only 3 or 4 days after Gallinha's death. It is evidently more 
rational to ascribe these numerous attacks to epidemic influence, which it is 
admitted was now present, than to contact with this woman, for the fact of 
which there is in truth not a shadow of evidence. 



Unrestricted intercourse with the Officers of the " Eclair " 105 



the illness of this child being gradually followed by that 
of two other cliildreii. But Dr. King affirms that these 
children were not taken ill until " about a month" after 
their father's return, and that it was not until the suc- 
ceeding month (the middle of November) that his wife 
was seized, " wdien the disease was general throughout 
the island/' It is also particularly to be observed, that 
a child in another family at Rabil, having no commu- 
nication with the family of Pathi, died about the same 
time as Pathi's first child, and that the disease broke out 
at least as early at Rabil as at Porto Sal Rey. 

Lastly, it may be urged in opposition to the opinion 
that the contagion was communicated by the crew of the 

Eclair/' that the small island on which the sick were 
landed and to which they were confined was a mile distant 
from the town of Porto Sal Rey, and that on reference 
to the map attached to Dr. jVpWilliam's report, it is ob- 
vious that the North-east trade wind must (according to 
the theory of Sir William Pym, as applied to the Neutral 
Ground at Gibraltar in 1828, See Note, Appendix No. 
I., p. 169) have dispersed the contagion if in existence, 
or carried it in a contrarv direction from Porto Sal 
Rey. 

For a more minute examination of the cases of the 
guards at the Fort, and of Pathi and others, as presented 
by Dr. M'William, w^e refer to the Note of Dr. Browne, 
Appendix No. III. (p. 306), who has there shown the real 
value of these cases, considered as links forming a chain 
of circumstantial evidence. 

The authentic facts attending the intercourse of the 
ship's company with the inhabitants of the island, afford 
further evidence that no infection could have been com- 
municated by the former to the latter. Thus, it is 
admitted that Captain Estcourt, the commander of the 
ship, went directly from the infected vessel to reside with 
Mr. Macaulay, the judge : no infection was communi- 
cated to Mr. Macaulay, or any part of his family. 

The officers of the gun-room — midshipmen, warrant, 
and engineer — on disembarking from the ship, took a 
house for themselves and their servants in the town, and 
mixed unreservedly with the inhabitants : no infection was 



106 This intercourse harmless till the usual Season of Fever. 



communicated to any individual with whom they had 
intercourse. 

The crew ohtained, or took leave to pay frequent visits 
from the small island to the town of Porto Sal Rev, 
where, according to Dr. M'WilHam, they resorted chiefly 
to the house of one Georgio, who kept a spirit store ; the 
only consequence of which visit, considered hy Dr. 
M' William a remarkable one, appears to have been that 
this man (and shortly afterwards " two females who 
associated with them) was attacked with headache and 
general fever on the evening of the day he was visited by 
the " Eclair's" people ; a result which admits of a more 
obvious solution than the communication of febrile con- 
tagion on the part of persons who were themselves in 
perfect health. 

The soiled linen of the officers and crew having been 
brought on shore on the first arrival of the vessel, was im- 
mediately given out to be washed to the washerwomen 
of Porto Sal Rey, and the careful search made after these 
women, brought to light no fewer than seventeen persons 
who were so employed. 

" The soiled clothes," says Dr. King, " linen, cotton, and flan- 
nel, which had accumulated in the officers' cabin from the time of 
their departure from Sierra Leoiie, were contained in at least 
12 bags, which were taken on shore at Porto Sal Rey the same 
evening the ship arrived, and distributed next morning (22nd 
August) to the washerwomen of the town. Noav, if the disease 
possesses the power of reproduction, its poison must [according 
to general opinion] have been as certainly communicated 
through the medium of fomites as by direct contact with the 
sick on board or at the fort ; yet none of the washerwomen nor 
any in their families were attacked with fever until November, 
showing an interval of 70 days after exposure to the in- 
fection." 

That it was not from any want of susceptibility to the 
influence of febrile poison that these women escaped the 
danger of this exposure to fomites was proved by subse- 
quent events ; for during the progress of the epidemic, all 
of these women, according to Dr. M 'William, with only 
one exception, were attacked with the prevailing fever ;^ 
two between six and seven weeks after the sailing of 
the Eclair five, two months ; two, three months ; 
three, four months ; and one, live months afterwards. 



Boa Vista situated loitliin the Yellow Fever Region. 107 



" None of the deaths," says Dr. M'William, " took place 
until fever was general in Porto Sal Rey, so that in none of 
these cases can the occurrence of the fever be fairly attributed 
to infectious matter conveyed by the linen." 

The Guards at the Fort v^ere many times relieved, 
and the soldiers were sent direct from the small island to 
their barracks in Porto Sal Rey, v^ithout conveying any 
disease to their comrades. On one occasion two soldiers 
who are stated to have lived in a room next to that in 
which the sick of the " Eclair " were lodged, on being 
taken ill, were conveyed at once to the barracks, yet they 
infected no one in their quarters. 

From a list drawn up by Dr. King, of the names of 
the islanders who were engaged as labourers on board 
the " Eclair," it appears that there were in all 63 persons 
employed in coaling, watering, and cleansing the ship. 
These men appear to have had unrestricted commu- 
nication with the ship's crew. According to Dr 
M'William, the whole of these labourers went to their re- 
spective homes every night, except those from Estacia 
and the Eastern villages, who generally slept at Porto 
Sal Rej. None of these men were themselves attacked 
with fever, excepting one (Pathi) whos^e case has been 
already considered ; none of them communicated fever 
either to their own families or to the persons \^ ith whom 
they lodged in the town, yet subsequent events proved 
that they as well as the washerwomen were sufficiently 
susceptible subjects, since, during the progress of the 
epidemic, the greater part of them were attacked by the 
disease ; none, however, within a month after the de- 
parture of the " Eclair ;" a few within two months, but 
the majority not until four or five months afterwards. 
: That the geographical position of the Cape de Verd 
Islands places them within the legitimate domain of Yellow 
Fever, and that this disease is no stranger to these islands, 
is admitted on all hands. According to Dr. M'William, 

The north-western part of the island where Porto Sal E,ey is 
situated, is low and flat, and almost wholly occupied by sand, 
which, blown up from the north-western shore through the 
water-courses, and other hollows, accumulates in mounds twenty 
and thirty feet high, which are drawn about and shifted by any 
little variation of the direction of the wind." 



108 Sandy Soils often productive of Malignant Fever. 



On the flat between Porto Sal Rey and the village of 
Rabil, which is about four miles to the southward of 
Porto Sal Rey, Dr. M'William states, that there is a point 
where the sea, when the waves are high — 

" Breaks over the elevated beach, and penetrates through 
the shingle, so as to accumulate, and run inland in the form 
of a narrow creek, from 200 to 300 yards from the sea shore. 
During the rainy season, this, in common with the other flats 
on the island, is inundated to a considerable extent, as is evident 
from the appearance of the soil in those places not covered with 
sand, as well as by the presence of a rude raised causeway, 
which the people have constructed over part of the hollow flat, to 
render it passable during the rains." * * * " Near the town 
is a hollow flat, spread over an area of about a mile, with the same 
soil and subsoil as that in the town. The central part of this 
area is occupied by a salt pan, which contains not less than 300 
troughs, each a foot deep, and about thirty feet square, into 
which the saltwater is poured, there to evaporate and form salt. 
During and for some weeks after the rainy season, the whole of 
this space is more or less inundated. * * * " The water is 
left to stagnate on the Eabil side, and as it dries up during the 
hot weather, little alluvial islets are from time to time exposed, 
which the people avail themselves of to raise a small crop of 
corn. Indeed the greater part of the ravine, from Rabil down- 
wards, is in a state of rude cultivation, and contains large green 
foetid pools, with all kinds of decomposing matter, the efiluvia 
from which was most offensive when I was there in May, 1846." 

Experience has shown, that such a condition of sandy 
soil is as fruitful a source of endemic and malignant fever 
as a marsh or swamp. Dr. Lind, who wrote nearly a 
century ago, expressly notices the unhealthiness of Boa 
Vista, particularly during the rainy season, stating that, 
" strangers who arrive here at this season are liable to be 
visited by a general sickness/' and instances its white 
sand as a mark of an unhealthy locality. Dr. Fergusson 
confirms the correctness of this indication of insalubrity. 

" That sandy soils/' he says, " should, in malarious climates, 
prove as productive of aggravated remittent fever as the swamp, 
has never been sufl^iciently explained. Certain it is, however, 
that they do so, in a marked and prominent degree. The 
Alemtejo and Algarve of Portugal — regions, I may say, 
altogether of sand — are the most prolific of fever of any in the 
Peninsula." 

Another instance is found in the unhealthiness of 



Tke Epidemic prevailed at the usual Endemic Season. 109 

Vera Cruz, whicli is spoken of by Me Cullocli in the 
following words : — 

"It is said to be the original seat of the Yellow Fever." 
[Bulama ?] " The city is well built and the streets clean, but it 
is surrounded by sand-hills and ponds of stagnant water, which, 
within the tropics, are quite enough to generate disease. The 
inhabitants and those accustomed to the climate are not subject 
to this formidable disease ; but all strangers, even those from 
the Havanah and the West India Islands are liable to the 
infection. No precautions can prevent its attack, and many 
have died at Xalapa, on the road to Mexico, who merely passed 
through this pestilential spot." 

Dr. King states, that if ever endemic fever derives its 
origin from a vitiated and malarious state of the atmos- 
phere, Boa Vista abounds with the elements for its pro- 
duction. Among these he enumerates swamps aud pools 
of stagnant water, in the immediate vicinity of Porto Sal 
Rey, and over the whole district of Rabil ; patches of rich 
alluvial soil near the other villages, the recognized sources 
of noxious exhalations ; the wretched food of the lower 
classes, and still more, the polluted atmosphere which they 
breathe in their crowded and ill-ventilated abodes, and the 
general disregard of cleanliness in their houses and streets, 
'^a combination of morbid causes," he says, which w^ould 
produce malignant fevers in any part of the world." 

The relative position of Boa Vista to the African 
coast would further naturally lead to the expectation that 
it must be subject to diseases of the same character, and 
no one disputes that this is the case. The residents of the 
island, military, medical, and civil, concur in stating that 
endemic, bilious remittent fever^ prevails there more or 
less every year ; that there is no season in which it does 
not carry off several of the inhabitants, and that it often 
prevails epidemically. 

" The testimony of the most intelligent men in the island," 
says Dr. King, " including Dr. Almeida, Senor Baptista (the 
Consul's agent), the Mayor of Rabil, the Judge of Fundas 
Figieras, and the Judge at Old Town, removes every doubt 
as to the fact that fever prevails to a certain extent, and 
carries off several of the inhabitants in the months of November 
and December every year ; and this endemic fever, which recurs 
annually, and which Dr. Almeida calls the bilious remittent, 
does not always present the same mild aspect and character ; 



110 Prevalence of Showers, Heat, Light Winds, and Calms. 

on the contrary, it is well known that in certain years the disease 
was epidemical, and in comparison with other seasons, very fatal/' 

Dr. M 'William records the fact, that such epidemic 
seasons occurred and proved unusually mortal in the 
years 1821-2, in 1827, and in 1833. 

It is most material to a right understanding of this 
whole subject to observe, that a Yellov^r Fever Epidemic 
had broken out at this very time in an adjoining island, 
St. Jago. It is stated by Dr. Stewart, in his Report 
in the Admiralty Correspondence, that " in the adjoining 
island at Porto Praya, there was Yellow Fever whilst 
the ship was at Boa Vista." Captain Simpson states 
that it recurred in the following year at Porto Praya ; 

is common there at times and quite endemic." 

That co-incident with the presence of the " Eclair" at 
Boa Vista one of these epidemic seasons was impending, 
was declared by the usual indications, which in warm 
climates precede and accompany such visitations. These 
premonitory signs on this occasion were a great fall 
of rain at an unaccustomed season ; the consequent accu- 
mulation of large quantities of stagnant water in and 
about the towns and villages ; the occurrence of extraor- 
dinary heat ; the prevalence of light winds with frequent 
calms rendering the weather extremely sultry and oppres- 
sive ; the appearance of sporadic cases of fever of more 
than common intensity ; the almost simultaneous outbreak 
of pestilence amongst cattle and other domestic animals ; 
and the visitation in greater numbers than common of 
destructive insects. 

These prognostications were so manifest as to excite 
the attention and alarm of the intelligent classes of resi- 
dents. The Governor- General states : — 

" Great falls of rain took place at a very advanced period of 
the season, which remained stagnant." 

The British Consul says : — ^ 

^' Up to the month of October, extraordinary heat and the fall 
of a large quantity of rain had been experienced, events which 
were surprising to the oldest inhabitants." 

The British Judge says : — ■ 

" Stagnant water had settled in great quantity at the back 
of the town, to which was joined great heat in the weather. 



Premonitory Sporadic Cases preceded the Epidemic^ 111 



Dr. King says : — 

''The information received on the island in 1846, fully 
corroborated what is stated in the above extracts, the periodical 
rains, contrary to what nsnally happens, did not set in till late 
in September. In October, November, and December the 
winds were light and variable, with frequent calms^ and the 
weather became in consequence extremely sultry and oppressive. 
The grass and green crops were nearly destroyed by the long 
previous drought, and what little appeared after the rains was 
devoured by the locusts which visited the island in greater 
numbers this year than was ever known to be the case before." 

Though Dr. M'William, on his inspection of the island 
with a view to ascertain the true cause of the pestilence, 
took no notice of any of these premonitory signs of its 
approach. Sir William Burnett was fully aware of their 
signification, and calls special attention to one of the most 
important of them in his Report to the Lords of the 
Admiralty. 

" I beg to lay before their Lordships," he says, ''^an extract of 
a letter from the Governor-General of the Cape de Verd Islands, 
and likewise extracts of letters from Mr. Macaulay and the 
British Consul, residents on the island of Boa Vista, distinctly 
showing the very remarkable state of the weather preceding the 
attack of the inhabitants of the island, which very important 
circumstance in a case of this kind, I regret to observe Dr. 

William has omitted to take any particular notice of." 

The event foreshadowed by these occurrences rapidly 
followed. As early as the middle of September a few 
cases of unusually malignant fever broke out, but as has 
been already slated, the first case that attracted public 
attention occurred on the 12th of October; a few others 
followed during the remainder of this month ; a still 
greater number broke out in the beginning of November, 
and the epidemic came to its height in the latter half of 
November, continuing to prevail throughout December, 
and recurring for several months in the following year. 

As in epidemic outbreaks in general, so in this mstance, 
individual or sporadic cases occurred some time before 
the appearance of the epidemic in its true and proper form. 
On minute inquiry, it was discovered that one if not two 
cases occurred as early as the I4th of September (Pathi), 
another on the 20th of September (Roque), and a third 
on the 21st of September (Agostinho) : no other cases 



112 This has been also recently observed at Demerara. 



at least none that attracted attention, appear to have oc- 
curred until the one ah'eady mentioned (Gallinha), on the 
12th of October. These sporadic cases all occurred in 
the ordinary localities of epidemic disease, and among in- 
dividuals belonging to the classes that usually furnish its 
hrst and chief victims. 

Events precisely similar preceded the outbreak of the 
Yellow Fever epidemic which is prevailing at the present 
time in George Town, Demerara. By dispatches from 
British Guiana^ dated the 6th of January, 1852, it ap- 
pears, tiiat although the disease did not assume an epidemic 
form until about the 30th of December, 1851, yet that 
individual cases of a highly malignant character occurred 
as early as the beginning of November ; and that concur- 
rently w^ith these sporadic cases a marked change was ob- 
servable in the type of the ordinary fever of the colony. 

I have observed," says Dr. Blair, in a letter addressed to 
Governor Barkley, and forwarded by His Excellency to Earl 
Grey, " that many cases of what appeared the ordinary fever of 
the colony seemed modified and exasperated, as if some new 
visitant had been added to the endemic malaria. Indeed, as 
early as the 7th and 24th of October a slight change in the usual 
manifestation of fever symptoms might have been observed in 
a few cases. But from the beginning of November the change 
became marked. Unusual flushing of the face, vascularity of 
the eyes, trifling haemorrhage, supra-orbital headaches, and 
epigastric oppression supervened as a first or second paroxysm 
of fever, and such cases were intercurrent with nominal inter- 
mittent. In one or two instances sudden and unexpected death 
occurred. 

" The evidence of a new virus (new because unknown for 
several years) poisoning the atmosphere, continued to accu- 
mulate, and its specific character has gradually developed itself 
until it has become too manifest that we are again invaded b}^ 
a similar epidemic to that of 1837." 

Dr. Blair further states that the epidemic commencing 
with " a very slight change in the character of the ordinary 
fever," continued to manifest its presence and progress by 
an increase in the intensity of the symptoms, and by the 
addition of new ones, which successively approximated it 
more and more closely to decided Yellow Fever, until 
at length, about the 30th of December, 1851, it assumed 
the perfect signs of the most virulent type of the disease." 



Unusual Mortality among domestic Animals. 113 



In a despatcli, dated George Town, 27tli January, 
1852, giving an account of the progress of this epidemic, 
Dr. Gavin states, that the present outbreak shows that 
Yellow Fever, like Cholera, returns not only to precisely 
the same localities, but even to the same houses ; and that 
immunity from the disease may be, to a great extent, 
guaranteed by the avoidance of the infected localities. 

Hitherto," he says, under this instruction [avoidance of 
infected locahties], the white troops have remained perfectly free 
from disease. Nothing: can more clearly mark the influence of 
localizing causes in the development of this disease than the facts 
in relation to the present epidemic. The parties upon whom the 
mortality has almost without an exception fallen, have been those 
who have been living, or who have remained for a determuiate 
period in the foulest localities of the tow^n, and by the river side — 
localities notoriously known as sinks of filth and impurity [see 
p. 45]. The disease has fallen almost entirely on the European 
sailors, in certain moorings, and on the Portuguese, who live in 
the 2:reatest filth, and whose shops and premises abound in the 
most offensive impurities. Comparatively few English inhabitants 
have been attacked, and those who have, dwelt in the very midst 
of the localities proved by experience to be the most offensive and 
dangerous, in such circumstances as the present^ to newly-arrived 
Europeans." 

We have already adverted to the testimony that at 
Boa Vista, in addition to other proofs of the presence of 
a stagnant and pestilential atmosphere, Ihere was the evi- 
dence derived from the prevalence of unusual sickness 
and mortality among domestic animals. 

" That the common air," says Dr. King, " which was inhaled by 
every living thing on the island was in an epidemic condition in 
the months of October, November, and December of both years, is 
sufficiently demonstrated by the simultaneous occurrence of uni- 
versal sickness and great mortality among the cattle (including 
horses, cows, mules, donkeys, and goats) at the very time that 
fever was raging among the inhabitants. And, further, there was 
this remarkable coincidence, that after an interval of some months 
and the disappearance of the disease both in man and beast, 
the same fever broke out again in the towns and villages about 
the rainy season of the following year, and was again accom- 
panied by the same murrain among the cattle, which in the two 
seasons proved fatal to two-thirds of the whole stock of the 
island." 

We submit that these considerations afford all the 

I 



1 14 Summary of the evidence relative to the " JEclair.'' 

evidence which the nature of the case admits of, that the 
sickness which affected the island on this occasion arose, 
not from the landing of the sick of the " Eclair," but 
from climatic and endemic causes. 

To sum up the whole of this case, then, it appears 
that the evidence in favour of the allegation that fever 
was imported into Boa Vista by the Eclair," amounts to 
this : that four men, not of the ship's crew, were attacked 
with fever while performing military service in a locality 
in which no fewer than 60 of the crew themselves were 
seized ; that one man not of the ship's crew who worked 
as a labourer on board the ship ''about eight" or two" 
days, had a slight attack of fever, while 62 men also not 
of the ship's crew, and who also in like manner worked 
as labourers on board the ship a longer time, were wholly 
unaffected ; and that a month after the sailing of the 
vessel, a woman was attacked with fever who happened to 
be a next door neighbour to two of the soldiers who had 
served on duty at the Fort — one of whom was uu' 
affected, and the other not even confined to bed — simul- 
taneously with the children of the labourer (Pathi) who 
resided in one of the dirtiest localities of the island. 

Against such evidence, if evidence it can be called, must 
be weighed the following countervailing considerations : — 

It is admitted that the ^' Eclair" had been exposed on 
the coast of Africa to the causes which usually develope 
epidemic fever in that country ; that intensity was given 
to those causes by circumstances which occurred at Sierra 
Leone, where she took in green wood as fuel, and where 
her men went on shore during the rainy and sickly 
season, and indulged in the unlimited use of ardent 
spirits ; that her hold was in a pestiferous condition, and 
that a quantity of putrid mud had collected between her 
timbers. It is proved that the fever which broke out 
under these circumstances was the common endemic 
African coast fever, which, it is admitted, is not con- 
tagious, and which is assumed to have become contagious 
on this particular occasion, expressly to account for its 
alleged importation. It is admitted that on the landing 
of the ship's crew at Boa Vista, though the men mixed 
freely with the islanders, — though the officers lodged in 
the town, — and though when some of them became sick, 



Evidence in siippoi't of importation unsatisfactory, 115 



they were nursed by the inhabitants, — there was no com- 
munication of the disease in a single instance. It is 
admitted that of seventeen washerwomen who washed the 
linen of the officers and crew, not one became infected, 
although all these women, except two, suffered severely 
from the disease at subsequent periods after the epidemic 
became general. It is admitted that with the exception 
of one case, which has been proved on inquiry to have 
been no real exception, 87* labourers worked on board or 
in the neighbourhood of the ship daily, and returned to 
their homes at night, without taking any precautious, — 
without becoming themselves infected, — and without com- 
municating infection to any individual of their f miilies ; — 
though, like the w^asherwomen, the greater part of these 
men suffered severely when the epidemic became general. 
It is admitted that the Cape de Verde Islands are within 
the Yellow Fever zone, and are liable to frequent and severe 
outbreaks of epidemic fever. It is admitted that the phy- 
sical and social conditions of "Boa Vista are eminently those 
which are found by universal experience to localize epi- 
demic diseases whenever an epidemic influence is present. 
It is admitted that the " Eclair " arrived at Boa Vista at 
the season of the year when endemic fevers usually prevail. 
It is admitted that at the very time of her arrival, Yellow 
Fever was actually prevailing at Porto Praya, in the 
island of St. Jago, into which it is not alleged that the 
disease had been introduced by importation. It is 
admitted that some time before the outbreak of the 
epidemic, the atmospheric and other conditions which 
usually precede and accompany the development of epi- 
demic disease, were so manifest as to attract general 
attention. It is proved that sporadic cases of the disease 
appeared, as is usual, some time before the presence of 
the epidemic was declared in its distinct and recogoized 
form. It is admitted that the epidemic influence ex- 
tended to animals as well as man, a mortal epizootic 
disease prevailing over the whole of the island at the 
same time. It is proved that the epidemic did not break 
out until about a month or six weeks after the Eclair," 
Avith all her crew, healthy and sick, had left the island. 



* The aggregate number of the lists furnished by Dr. M'William. 

I 2 



1 16 Opinions of Gov.- General^ Mr. Macaulay^ 8c Capt. Simpson. 

It is admitted that a similar epidemic appeared among 
men and animals the following year, not imported, but 
entirely of local origin. 

A consideration of these circumstances has satisfied 
most of those who have inquired into the case, that the 
arrival of the Eclair " at Boa Vista with fever among her 
crew, and the occurrence of a similar disease on the 
island, were mere coincident events, and that the appear- 
ances which might at first view have given some colour 
to the notion of importation were fallacious. 

Among those who arrived at these conclusions w^ere — ■ 
The Governor-General, who says:— 

"The disease was perfectly endemic, not one of those who 
emigrated to the different islands of the Archipelago had the 
disease or communicated it to others. It did not make its 
appearance till a month after the departure of the steamer. 
. . . The disease had its origin in the great falls of rain which 
took place at a very advanced period of the season, and which 
remained stagnant in the neighbourhood of the place." 

Mr. Rendall, the Consul, who says : — 

" The competent officers of the ' Eclair' at all times pleaded 
that the fever which had appeared and rested on board was 
nothing more than the 'common African coast fever;' the 
opinion of the medical men on the spot continued to be that the 
fever was merely the common Afr ican fever, and that no danger 
existed of its spreading among the people." 

Mr. IMacaulay, the Judge, who says : — 

" So long an interval had elapsed between the departure of 
the ' Eclair' and the appearance of the first serious case of 
fever in the town, that we were all disposed in the first instance 
to attribute it, as well as the general sickness of the place, rather 
to stagnant water, which had settled in great quantity at the 
back of the town, joined with the great heat of the weather and 
the dirty state of the streets. The ' Eclair' had left Boa 
Vista nearly a month before any case of fever exhibited 
itself in the town. . . . No injury whatever had resulted from 
the unrestricted intercourse which had subsisted during the 
whole of the ' Eclair's ' stay in the harbour, between the 
officers and men (not in hospital at the iort) and their friends 
on shore." 

Captain Simpson, who says — 

" If I give my opinion on the fever that was on board the 
' Eclair,' I should say it commenced at Shebar ; and it was to be 
expected that men being exposed in boats to night duty during 
the rains, would be sickly: that it was likely to be much increased 



Opinions of Sir William Burnett and Dr. King, 1 1 7 



at Sierra Leone by the long continuance of the vessel there, and the 
men having leave to go on shore during this season, when this 
place is so very unhealthy, and seamen always so incautious ; the 
occupation of the ' Eclair's ' officers and ship's company on board 
the ' Albert ' in clearing the holds, at ail times a very dangerous 
work in the Tropics ; and the use of green wood for fuel. ^ In fact, 
I should have been very much surprised if the ' Eclair ' had not 
been sickly." 

Sir William Burnett, who, in reporting on tlie case fo^ 
the Lords of the Admiralty, says : — 

*• After a careful perusal of the papers he (Dr M'William) 
has sent, I am compelled to say that I cannot conscientiously ar- 
rive at the conclusion the Doctor has done, namely, that the 
fever was occasioned by intercourse with the ' Eclair.' " 

Sir William Burnett adds, with reference to the general- 
question of importation : — 

" With respect to the importation of the disease into various 
places, except in one instance, and that even is surrounded with 
doubts (I mean that of Her Majesty's sloop 'Bann'), I en- 
tirely disbelieve it. Both the surgeons of Bermuda Hospital 
most distinctly deny on tv>^o occasions that the epidemic which 
prevailed in 1843 was imported or contagious ; I have also 
caused the medical reports of Jamaica Hospital for more than 
twenty years to be examined ; and though hundreds of patients 
with yellow fever in all its most appalling forms, including black 
vomit, &c., have been treated in that establishment, not one of 
the medical officers in charge of the hospital have ever hinted 
at the disease being contagious ; and if it be needful I can cite 
numerous other instances." 

As to the apprehension that the crew of the " Eclair" 
might have imported the disease into England, he says : — 

" I have no hesitation in declaring my firm belief that the 
sick men of the ' Eclair,' when that ship arrived at the Mother- 
bank, might have been landed at Haslar Hospital and placed 
in the well-ventilated wards of that establishment without the 
public healrh suffering in the smallest degree. It is a fact well 
known, and of the truth of which I can give the most satisfactory 
proof, that during the autumn of every year merchant-ships 
arrive in our harbours loaded with the produce of the coast of 
Africa, having perhaps lost great part, nay in some instances 
the whole, of their crew by the fever of the country ; or some are 
still labouring under fever when the ship arrives in the Thames, 
and are sent to the hospital in that state ; yet no instance is 
known of any infection having been produced by such procedure ; 
in fact it is perfectly certain that it never did take place." 



118 Alleged importation hy the " Growler'' into Barbados. 
Dr. King, who says : — 

" The inhabitants in general are firmly persuaded that the 
fever was imported by the ' Eclair' and afterwards spread 
throughout the island b^ contagion from one person to another, 
I have taken considerable pains to trace out and discover the 
supposed morbid concatenation, but in vain. It becomes, there- 
fore, a duty to express my opinion decidedly, that there is no 
satisfactory proof of the disease having been propagated by con- 
tagion, or from a specific poison which is said to emanate from 
the bodies of the sick, the dying, or the dead." 

We have entered into this particular examination of 
the case of the Eclair " because as has been already 
stated, it is the one on which the greatest reliance is 
placed in proof of the importation of epidemic disease. 

On the outbreak of the Yellow Fever epidemic of 
1847, at Barbados, it was affirmed as usual, that this 
was another case of importation ; but the real facts are 
tlius stated by Dr. John Davy : — 

" An opinion, I am informed, has been expressed that the 
disease was imported, and by Her Majesty's war-steamer 
' Growler,' from the coast of Africa. That ship was employed 
in conveying liberated Africans to the West Indies. She left 
Sierra Leone on the 12th of November, 1847, and arrived at 
Trinidad on the 5th of December. During the voyage 46 deaths 
occurred amongst the emigrants from chronic dysentery, and 
two deaths amongst the crew from fever. The emigrants were 
landed at Port of Spain. No fever was there introduced, al- 
though no precautions were taken that I have been able to 
learn to prevent, unrestricted communication. She took her 
departure from Trinidad on the 8th of December; arrived 
at Barbados on the 10th ; proceeded from thence on the I8th, 
and reached the Bermudas on the 24th. There, according to 
established usage, having come from the coast of Africa with 
fever on board, she was placed in quarantine : the crew landed and 
kept apart— the sick from the well — and the vessel thoroughly 
cleaned and fumigated. On examining the holds and bilges, 
they were found in a very offensive state, from accumulated 
vegetable matter, rice, chips, and shavings, in a decomposing 
state. The atmosphere in the carpenter's store-room would 
not support combustion. The fever was not communicated at 
the Bermudas to a family of five persons associated with the 
sick on shore ; but two individuals from the shore, who were 
engaged on board in conducting the cleaning of the vessel con- 
tracted it, as did also a certain number of the crew similarly 



Alleged importation of Yellow Fever into Oporto , 1851. 119 



employed, and only those so employed. The total number of 
cases of fever under treatment from the ' Gro\yler,' were 75, 
of which three only terminated in death, 72 having recovered. 
These particulars I have collected from an extract from the 
Journal of Mr. Eobert M'Crae, Surgeon of Her Majesty's ship 
' Growler,' a copy of which interesting doument is now before 
me, with which I have been favoured by the head of the medical 
department of the navy, Sir William Burnett."* 

At the recent Sanitary Conference at Paris, particular 
stress was laid by one of the delegates, JM. Grande, on 
the case of the '^Tentadora" and ''Duarte/' w-hich. 
vessels, he alleged, had very lately introduced Yellow 
Fever into Oporto. It appears that these vessels arrived 
at Oporto from Brazil during the autumn of last year, 
that cases of Yellow Fever occurred on board during^ 

a 

their passage, and that several persons who visited the 
ships at Oporto were attacked with Yellow Fever. It 
was argued by Dr. Sutherland that these facts, supposing 
them to be correct, atford no proof of importation ; that it 
was only those individuals who actually went on board 
the ships who \^ ere attacked ; that none of those who 
were attacked communicated the disease to any person in 
the town, though no precautions were taken to isolate the 
sick ; that this case offers an additional example of the fact 
that it is the ship which is to be feared, and not the country 
from which she arrives ; that, consequently, it Avas ab- 
surd to put arrivals from Brazil under quarantine; and 
that the only rational means to be adopted in the present 
instance was to take immediate measures for cleansing 
the infected vessels. 

Had it happened by any coincidence that an outbreak 
of fever should have taken place at Oporto within any 
reasonable time after the arrival of these ships, it would 
have been asserted, on so-called incontestible evidence, 
that Yellow Fever had been imported into this town, as 
was affirmed in the case of the " Eclair" at Boa Vista. 

We deem it needful to advert only to one instance more 
of alleged importation ; namely, the introduciion of the 
Yellow Fever epidemic of 1828 into the garrison of Gibral- 
tar by the ship " Dygden." We beg to call special atten- 



* See Note. Appendix I., p. 227. 



120 Alleged importation of Yellow Fever into Gibraltar 

tion to this case, because it has been more rigorously ex- 
amined than any other, and because on that account it 
exhibits a better specimen than can usually be obtained of 
the manner in which the evidence for these cases is com- 
monly got up. 

The most positive assertions having been made that 
this epidemic was introduced into Gibraltar by a ship 
from the Havannah, the " Dygden," the then Secretary of 
State for the Colonies, Sir George Murray, appointed a 
Special Commission to inquire into the facts of the case ; 
consisting of the Judge Advocate, the Colonial or Civil 
Secretary, the Captain of the Port, and head of the 
quarantine department, the Town Major, or head of the 
police, the Principal Medical Officer of the garrison, and 
a Staff Surgeon. It was the desire of Sir George 
Murray that the Governor should act as president, on the 
ground that ''as the proposed investigation is merely to 
ascertain a fact, it may be more properly accomplished by 
the careful examination of impartial witnesses than by the 
application of scientific research ;" but Sir George Don, 
"not finding himself equal to the task," appointed, by 
desire of the Secretary of State, conveyed in a subsequent 
dispatch, the British Superintendant of Quarantine, Sir 
William Pym, to preside in his place. 

The facts alleged and attempted to be established before 
the Board with a view to prove that this epidemic was 
imported by the ship " Dygden " were, that this ship had 
arrived from the Havannah with Yellow Fever on board ; 
that while in quarantine in the bay, she was visited from 
the garrison by a family of the name of Fenic, and that 
the first cases of the epidemic occurred in this family. 

The first witness called to prove this alleged visit to 
the ship was a woman of the name of Villalunga, who 
stated that she lived in the yard of Fenic's house ; that 
Fenic was a cigar maker, that she assisted him in making 
cigars, that she heard the boy (Fenic's son) say that he, 
his sister and his father had been on board the ship in the 
bay on Sunday, the day before the boy was taken ill, and 
that the boy told her that they had been on board ''to 
eat, drink, and make merr}^," and " that his father had 
sold tobacco on board the ship." 



hy the " Dygden^^ in 1828, unsupported by Evidence, 121 



The next witness brought forward was a child Caffiero, 
1 1 years old, who stated that he was in the habit of play- 
ing with the two Fenics : that he lived very near them ; 
that lie played with them every day before their death^ 
and that he saw them every day when they were sick in bed. 

On these statements the Judge Advocate, Mr. Howell, 
observes : — 

The only evidence which up to this period (April 10th) had 
been given to connect the illness in Fenic's family with a visit on 
ship-board^ is the hearsay tale told by Villalunga, nor did she 
give to Fenic and his two children any companion in their alleged 
Sunday excursion." * * * 

Eight days after his examination above mentioned, the boy 
Caffiero re-appears as a witness (viz., April 18th) with a story 
entirely new, and which, if credible, would be extremely material ; 
because he affects to speak of facts which had before rested on 
the hearsay evidence of Villalunga, but of which facts Caffiero 
now, after the lapse of eight days, represents himself to have been 
an eye-witness. On this his re-appearance, however, he carefully 
abstains from giving any date, either day of the week, or month, 
or even season of the year. This cautious avoiding of dates may 
not unfairly be attributed to the variances between himself and 
Villalunga, in their respective journals of the illness of Fenic's 
children. Caffiero now says, "I knew Salvo and Catalina Fenic, 
and went on board ship with them ; / do not recollect the day. 
We went on board a three-masted ship. I do not recollect to 
what nation it belonged. We remained on deck, and did not go 
below. We remained on board about one hour. Fenic, the 
father, took us on board; he rowed the boat himself ; he ate and 
drank on board, and then brought a hvndle of clothes on shore.' 

Until this time, neither he nor Villalunga said anything about 
a bundle of clothes. 

" This boy's second evidence thus proceeds : — ' I did not 
understand the language of the people on board the ship ; 
they appeared to speak like Jews or Moors. 1 did not go on 
board more than once. When we landed on the wharf, the 
Maltese,' i. e. Fenic 'gave me some money ^ a pistoreen, and told me 
not to say anything to anybody about our having been on board.^ 

"The effect which this was designed to produce is obvious, viz. 
that the ship visited was in quarantine, and Fenic, the Maltese, 
was conscious that he had committed an offence against the 
quarantine laws which rendered it necessary for his own safety 
that he should bribe this boy to secrecy. This story is full of 
incongruities; it is not probable that a man should select for his 
Sunday excursion, to eat, drink, and make merry, a ship in 
quarantine ; it is more improbable still that Fenic should 



122 



Examination of evidence in support of 



gratuitously place himself in extreme peril, by taking with him 
(to be witnesses of his offence) children of the artless ages of 10, 
11, and 13, on an expedition which in his own judgment, as 
demonstrated by his own act, he is convinced exposes him to 
severe punishment. 

But with regard to the ship *Dygden,' I find that she had 
already received pratique, and had been admitted to free inter- 
course with the shore, on the 6th of August, ybwr days previously 
to the alleged visit of Fenic, the date of which, notwithstanding 
Caffiero's loss of memory on his second examination, had already 
been ascertained by Yillalunga to have been Sunday, August iOtb, 
on which day Fenic, therefore, could commit no crime by going 
on board ; and the story of the bribe and injunction to secrecy 
resolves itself into a clumsy and ill-disguised attempt at giving a 
colour of guilt to a fabulous occurrence which, even if it had been 
real, would have been guiltless. 

His second evidence concludes thus : — ' My mother was a 
washerwoman, and washed for a black woman who lived next 
her. Fenic's wife refused to wash the bundle of clothes that he 
brought ashore ; he offered them to my mother, who also refused 
them; he then gave them to an Englishwoman: I knew her: 
she is dead: I do not know her name, nor where she livedJ* I find 
by my notes that he added, *^This occurred during last winter,' 
although the words are not entered upon the minutes. He was 
then asked, ' What season of the year was it that you were on 
board of ship?' To which he cautiously replied, 'It was either 
summer or winter, I believe.' 

" Evidence such as this, and given as I saw it given, bears on 
its face every character of falsehood ; and disbelieving as I do 
this boy's whole story, and, at the same time, considering his 
extreme youth, the testimony given by him has upon my mind 
the further operation of tainting with more than suspicion all the 
other evidence proceeding from the same class of witnesses, which 
consisted chiefly of hearsay in conversations with persons who had 
since died; because it would seem that this child must have been 
an instrument in the hands of some one of maturer age." 

The suspicion attached to the second appearance of this 
child is couhrmed by a similar re-appearance of Villalunga, 
who, after sixteen days' absence from the Board, on the 
24th of April, again presents herself as a witness. She 
now remembers that Mrs. Fenic had asked her to wash 
some clothes ; that she did not wash them, being herself 
indisposed; but that she was told by Mrs. Fenic that 
she put these clothes out to be washed. 

Mr. Howell thus comments on this second appearance 
of Villalunga : — 



alleged importation by the Dygden " into Gibraltar. 123 

" I have observed that Caffiero added to his original testimony so 
much as to give to it a new character altogether ; I now observe, 
that six days after Caffiero's amended testimony, and sixteen days 
after her own original examination, the woman Villalunga comes 
back with a new story, of which, singularly enough, the principal 
point is made to coincide with the alterations and emendations in 
the evidence of Caffiero." 

On an examination of the surviving member of the 
Fenic family, the widow of Fenic himself, it appears that 
she gave a positive denial to this alleged visit of her hus- 
band and children to the ship. 

She was at my desire/' says Mr. Howell, particularly 
reminded that the duty v^'hich she owed to society required her to 
disclose everything that she knew ; and from the ingenuous 
manner in which her evidence was given, I am led to believe that 
she spoke the truth. 

" She declared that she did not know the cause of her chil- 
dren's illness : — * They were attended by Dr. Lopez, who is dead, 
and who said they had a tabardillo and indigestion, caused by 
eating green Jigs. He did not say what was the cause of the 
tabardillo. My husband was a cigar-maker ; but he did not go 
on board ship either to buy tobacco or to sell cigars. Neither my 
husband nor my children went into the bay at any time during 
last, summer or autumn. I know this : because, if they had gone, 
they would have told me, and they did not tell me.' Nor, 
indeed, is it to be supposed that the children would not have told 
their mother, and that the husband would not have told his wife, 
that which all of thern are declared to have communicated so 
freely to other people." 

On being cited before a Public Notary at Gibraltar 
(November 14th, 1829), this witness still more parti- 
cularly deposed — 

That it was utterly untrue that her husband went on board 
any ship in the bay at any time last summer ; that, on account of 
his age and infirmity, he had not been in a boat for ten years past; 
that she is equally certain that her two children never went on 
board any boat or ship ; that, with respect to the boy Caffiero, 
neither she nor any of her family knew anything about him ; and 
that his story of having gone on board the ship with her husband 
and her two children, ' is a made-up falsehood.' " 

Mr. Howell sums up the result of his examination of 
the evidence adduced before the Board respecting the Fenic 
family in the following words : — 

Having thus examined in detail the evidence adduced to 
connect the illness of Salvador Fenic (the alleged first case of the 



124 



Examination of evidence in support of 



epidemic) with the ' Dygden/ — and no other vessel has been 
pointed at, — I find not only that it completely fails to make out 
even a prima facie case, but also, from the whole complexion 
of the evidence, I am convinced that the storv of Fenic's visit to 
that vessel on the lOth of August is, from beginning to end, a 
fabrication." 

Apparently in anticipation of a failure to connect the 
illness in Fenic's family with a foreign source, much 
testimony was given before the Board derived, as is stated 
by Mr. Howell, " through channels most impure," about 
instances in which foul clothes are supposed to have been 
brought ashore by sailors arriving from the Havannah, in 
the early part of the epidemic, and which foul clothes 
infected the washerwomen. 

After showing at some length the discrepancies and 
contradictions which proved the whole testimony adduced 
on this point to be utterly worthless, Mr. Howell says : — • 

Here I leave the journals of washerwomen, and the tattle of 
their gossips, remarking this fatal objection to each washing-tub 
anecdote, however circumstantial, that not one of them goes hack so 
far as to precede, and therefore to account for, the alleged first case 
of the epidemic, namely, that of Salvador Fenic, who, as we are 
told, fell ill on the \Uh of August, and upon whose single case, 
therefore, the proof of importation rests. And if the attempt to 
connect the illness of Salvador Fenic with a foreign source be, as 
I hold it to be, a complete failure, how is the illness of the boy 
Caffiero to be accounted for ? And to what is to be ascribed the 
illness of Mr. Martin's child on August 16th, a case quite as early 
as that of Caffiero, and which has not been attempted to be traced 
to importation ? not one of the washinor-tub cases beingr anterior 
either to that of Mr. Martin's child or to that of Caffiero, both of 
which are unquestioned cases of the epidemic." 

It was essential to the proof of the connection of the 
" Dygden " with the outbreak of the epidemic, to esta- 
blish the fact of the existence of Yellow Fever on board 
the ship. No proof of this appears to have been adduced.* 
On the contrary the captain of the ship declares that no 
such disease existed on board ; the head of the Quarantine 
department, after an official examination into the fact, 
affirms that there is no evidence whatever to disprove the 
truth of the captain's statement, and the Quarantine 
Medical Officer, after " a minute inspection of the captain 



* See Appendix I., p. 214. 



alleged importation by the " Dygden^' into Gibraltar. 125 



and crew," states that he "found them all in perfect 
health." 

have minutely inspected the captain and crew," he says^ 
whom I found in perfect health. The reason for putting this ship 
in Quarantine for 40 days was, that two men died on the passage. 
It is now 66 clear days since the first man died, and 61 since the 
death of the last, and nothing like disease has since appeared, nor 
have I the most distant reason to apprehend danger to the public 
health from any circumstances connected with the ' Dygden.' " 

Mr. Howell calls special attention to this report of the 
medical officer : — 

" This report," he says, was written, as it strikes me, under cir- 
cumstances which entitle it to much consideration. This ship had 
been officially pointed out to him (as the Medical Officer of Quaran- 
tine) as being strongly suspected. The responsibility of his office was 
thus brought fully before his eyes, and he had then no motive for 
making a false report of his inspection of the ' Dygden's ' master 
and crew, because the epidemic had not at that period commenced. 
If he had observed any i-easonable grounds for suspicion, he had 
only to fall in with the rumour and recommend that none of the 
persons or susceptible articles on board should be permitted to 
land. The conduct and declarations^ therefore, of Dr. Hennen, as 
a responsible public officer, under such circumstances, when, if he 
erred at all, it would probably be on the side of over caution, I 
hold to be most material." 

Such is a fair specimen of the evidence adduced on this 
occasion to establish a positive case of importation. It 
breaks down at every point. There is complete failure 
hi the proof that Yellow Fever existed on board the ship ; 
there is complete failure in the proof that there was the 
slightest connection between the ship and any persons on 
shore, and there is even failure in the proof that the 
individuals who are alleged to have introduced the disease 
were really affected with a malady of the same nature as 
the epidemic that subsequently prevailed. 

The Judge Advocate thus states the conclusion at which 
he arrived after a careful examination of the proceedings 
of the Commission. 

I am of opinion that the evidence brought forward has totally 
failed to prove that the late epidemic disease was introduced from 
any foreign source, either by the Swedish ship ' Dygden,' or by any 
other means ; and I am further of opinion that the late epidemic 
had its origin in Gibraltar." 



126 Comments on the proceedings of the Board of Inquiry 



Medical observers on the spot, not members of the 
Board, but who carefully watched its proceedings, it is 
believed, without any exception, arrived at the same 
conclusion. Thus Dr. Smith sums up the result of his 
examination of the subject in the following words 

That it was not imported I think every candid man will admit 
who has deliberately weighed the evidence given on the subject 
before the Board of Commissioners, and the facts I have stated. 
Every endeavour to establish the importation doctrine has failed, 
and both the Colonial Secretary, Sir George Murray, and 
Sir James McGrigor, Director-General of the Army Sledical 
Department, I have heard, are convinced there is not the slightest 
ground for such a belief ; but, on the contrary, that there is every 
reason to suppose the disease owed its origin to causes within the 
walls of the garrison.'' 

Several comments were made by those who paid 
attention to the subject at the time, on the manner in 
which this investigation was conducted, which appear to 
deserve notice. 

Complaints were made that the result of the inquiry 
was prejudged. In proof of this it was found that the 
President of the Board a few days before it held its first 
meeting, addressed to the military secretary of the gar- 
rison an official letter in which, among other observations 
directly tending to a prejudo^ment of the case, he affirms, 
that, " the fever in question has often been traced to impor- 
tation, and against this source only must we look for its 
" prevention." 

It appears further that before the meeting of the Board 
an official intimation of the views and wishes of the local 
authorities was promulgated in the Government Gazette, 
into which nothing is admitted but by authority, in the 
followin£f words : — 

"The scourge from which we have been by Divine Providence 
just delivered must be an exotic of some kind. It is in its origin 
independent of everything inherent in the soil which we inhabit, 
incapable of existing among us during the winter months, and 
totally distinct from and unconnected with the Remitting and 
Intermitting Fever, which may be said to be unknown in this 
garrison."* 

'''Two causes," observes Mr. Howell, "concurred to operate 



* See Note, pp. 94, 95. 



as to the Origin of the Epidemic of 1828 at Gibraltar. 127 



injuriously upon the proceedings of the Board : First, the con- 
viction universally prevalent among the civil population of Gib- 
raltar, that the prosperity of that community would be undermined 
if it should be proved that the epidemic had been generated on the 
spot, because of the prohibitions and restrictions which it was 
anticipated would in that case be inflicted upon its commercial 
intercourse with other places. Hence the notion that not only the 
last epidemic, but that all its predecessors had been imported from 
some foreign country was not only anxiously supported by the 
unanimous voice of the civil community, but it was with equal 
unanimity believed tliat a different doctrine would be fatal to the 
commercial prosperity of the place. From this feeling of self- 
interest it is to be admitted that the military were exempt, a 
distinction between the two classes which ought to be taken into 
account in estimating the value of the evidence taken by the Board, 
and more especially the evidence of the medical practitioners. 

''The second cause operating injuriously upon this inquiry, was 
the publication, in the official Government nev^'spaper, (into which 
nothing is admitted except by official authority), on January 12, 
1829, of an article authoritatively announcing that the late epidemic 
had been imported into Gibraltar, and denouncing as void of 
common sense any person who should hold a different opinion. 
This official notification of the feelings of the local Government 
(preceding as it did by only 12 days the appointment of the Board 
of Inquiry) could hardly fail to encourage evidence on one side, 
and discourage evidence on the other." 

Complaints were also made that there was a partial 
selection of witnesses. 

It always appeared most extraordinary and un justifiable," says 
Dr. Gillkrest, ''that on this kind of inquiry, which was intended 
by the Secretary of State to be so beneficial to the interests of 
humanity, the Superintendent of Quarantine as president, should 
have assumed the right in several instances of selecting the wit- 
nesses, which obviously prejudiced the question, and by which 
much of the truth was intercepted. 

" Several medical officers of the garrison who had much expe- 
rience respecting the progress of the epidemic, were either not 
examined at all, or only in a very imperfect manner. I was 
among the latter, being surgeon to the 43rd Regiment, and present 
during the whole epidemic. After a very limited examination, 
I officially informed the President, by letter, that I had much to 
state; but like others. I was not called afterwards. 

*' From what I felt due to the service of which I had been a 
member for so many years, as well as the cause of truth, 1 was 
induced to protest against such proceedings, which protest will, I 
presume, be found with the documents connected with the inquiry 
forwarded from Gibraltar to the Colonial Office in London." 



128 



No JEvidence whatever in support of Importation. 



Complaints were further made of the mode of collecting 
the evidence adopted on this occasion, which was such 
as to excite the suspicion of some of the members of the 
Commission, and to lead eventually to their condemna- 
tion of it, and their repudiation of the Report which was 
founded upon it. See Letter of Sir George Murray, and 
reply of Colonel Chapman, the Civil Secretary, p. 274 ; — 
also Report of Judge Howell, Appendix, II. pp. 245,273. 

We need pursue no further this examination of the 
cases of alleged importation. We apprehend it will be 
apparent, from the specimens we have adduced of the 
kind of statements on which they rest, that no one would 
trust to such evidence in the ordinary concerns of life ; 
and yet the belief in the fact of importation, and the pro- 
ceedings actually consequent on that belief, involve 
questions of health, property, and life, to an incalculable 
extent ; and, we submit, that the clearness and weight of 
evidence required to justify such proceedings, should be 
proportionate to the momentous consequences that may 
result from them. 

When a disease suddenly breaks out in a town or dis- 
trict, and such disease is believed to be of foreign origin, 
and highly contagious — 

''A cordon," says Dr. Smith, is immediately established, the in- 
habitants are shut up, all communication cut off, and those that are 
not fortunate enough to escape before alarm is excited in all proba- 
bihty fall victims to the disease. Fortunately for us in Gibraltar, 
we have had the means of escape in our hands, and a removal to 
the Neutral Ground, Europa Flats, Windmill Hill, or the Bay, 
ensures safety. But this is not the case in Cadiz and many other 
large towns. There the inhabitants must patiently wait their fate, 
like people in a house on fire with the doors and windows shut to 
prevent their getting out.." 

" An ophiion," sa.ys Mr. Amiel, " has been very prevalent that 
the epidemics which have appeared in this garrison and on the 
coast of the Peninsula have constantly been imported in vessels 
from Vera Cruz, Havannah, or the West India Islands. But 
this opinion appears to be grounded rather on popular pre- 
judices and the illusions of terror than on philosophical investiga- 
tions. * * * * Xhe arrival in this garrison of one or more 
persons ill of this malignant fever at the breaking out of the epi- 
demic, will not prove its foreign origin nor its propagation by 
contagion ; for, on the one hand, fever has broken out where 



Willing belief in Importation by the Ignorant. 



129 



there was not the least possibility of foreign introduction, and on 
the other, a number of people labouring under it have sometimes 
been landed in other places without injury to the health of the 
inhabitants." 

" The only instance of public precautionary measures," says Dr. 
Blair, "being adopted under the impression that the epidemic dis- 
ease was contagious, was at Berbice, at Fort Cange. Captain War- 
burton, at the instance of assistant surgeon Turner, established a 
rigid cordon, and prevented all intercourse with the town of New 
Amsterdam. Previous to this no case had appeared in the garri- 
son. An effect of the cordon was to prevent huxters and others bring- 
ing in fresh provisions, fruit, &c., to the soldiers. The soldiers were 
also of necessity thrown on their own resources pour passer le temps, 

" However, notwithstandingf all communication havingr been 
cut off with the town, the Yellow Fever epidemic soon appeared in 
the garrison, and poor Dr. Turner fell a victim — not to the Yel- 
low Fever, according to the practitioner who attended him, but — 
to inflammatory fever, the result of extreme fatigue, mental 
anxiety, and chagrin." 

" The infractions, whether direct or open," say the Committee 
of Physicians of Barcelona, of the strict cordon by which the 
place was surrounded, gave occasion to the people themselves to 
turn it into ridicule, bestowing upon it the most contemptuous 
epithets. 

The vexations experienced by those who quitted Barcelona, 
and the arbitrary measures adopted by each separate community, 
even in the highest mountains, against an imaginary contagion, were 
an insult to humanity, and a proof the most authentic of the igno- 
rance in which nations may be plunged by the vicious routine of 
sanitary [quarantine] laws." 

•* In every chme," observes Humboldt, " men fancy to derive 
consolation in the idea, that a disease which is considered pes- 
tilential has been brought from abroad. This belief flatters 
the national pride. To inhabit a country which produces epi- 
demics might be deemed a humiliating circumstance ; and it 
is more satisfactory to consider that the malady is a foreign 
one, and that its breaking out has been merely the effect of an 
accident against which it will be easy to guard in another instance. 
The people immediately adopt this explanation of the origin of 
the disease, because it is easily comprehended. The medical 
men, on their side in general, rest satisfied with it, because the 
word importation relieves them from all responsibility, and from 
the trouble of investigating the nature and real cause of the 
disorder. From this has arisen that remarkable facility with 
which the doctrine of importation has been eagerly received by all 
classes when an epidemic manifests itself in a country ; and a 
vessel, a traveller, or a parcel of goods arrive at the same time. 
So it is that the Havannah, Vera Cruz, and the sea-port towns of 

K 



130 Official Authority tvhere differences of scientific opinion 



the United States^ constantly accuse each other of the importa- 
tion of the Yellow Fever during the sumnier months, just as the 
inhabitants of Egypt refer to the arrival of Greek vessels the 
appearance of the plague ; when in Greece and Constantinople, 
the disease is attributed to vessels coming from Alexandria and 
Rosetta." 

With reference to several of the preceding cases of 
alleged importation, the apparent want of skill on the 
part of the medical inquirer in examining witnesses on 
questions of fact, and extorting the whole of the truth 
from the reluctant, the intimidated, the prejudiced, or the 
interested, can scarcely have escaped attention ; but there 
would seem to be a peculiar disadvantage for the dis- 
covery and statement of the truth, on this subject, under 
which the medical departments of the army and navy 
are placed — that the discipline which, in other respects, 
is so essential to the service, naturally and often, perhaps 
unconsciously, predisposes the subordinate officer to 
adopt the views, and support the opinions which are 
understood to be most acceptable to the head of the 
department upon whom his future professional prospects 
mainly depend. To the honour of both services, it must 
be stated that examples are of constant occurrence 
in which all considerations of this kind are disregarded : 
but such observations as the following could scarcely 
have been made, if the difficulty were not a real, and 
sometimes a very oppressive, one. 

At one period of medical rule in this garrison," says Dr. Smith, 
every variety of fever was ordered to be returned under one head. 
Such indeed was the thraldom of the military medical press (if I 
may so use the expression) in Gibraltar, from the termination of 
the epidemic fever of 1814, until the arrival of the late Dr. 
Hennen, in 18"26, that it was considered a most wicked heresy 
for the surgeon of a corps to return fever under any other head 
than simple-continued fever. The consequence is, that although 
febrile diseases are the most frequent of the numerous diseases 
treated in the Military and Civil Hospitals, no correct table of 
fevers can now be framed from the returns of these establishments^ 
no distinction whatever being drawn between the different species 
of remittent and continued. The authors of such a measure can 
best answer for themselves. To me it appears to have been an 
attempt, and one too successfully made, to obstruct the advance of 
truth, short of nothing but the direct application of the bayonet's 
point ; and it is due to the memory of Dr. Hennen to state that 



prevails^ liable to influence the results of Inquiry. 131 



he had not assumed the charge of the department two weeks 
before he abrogated this mischievous state of things. This 
measure soon showed that neither the intermittent, remittent, or 
continued Yellow Fever, were such uncommon forms of disease in 
the garrison, as Sir Wilham Pym and others of his school, had, 
for a series of years, endeavoured to represent. Instead of re- 
mittents being rare, and intermittents never occurring, in GibraUar, 
Dr. Hennen says, at page 119 of his Medical Topography, 'I 
have no hesitation in asserting, that remittent fevers are of frequent 
occurrence* (speaking of Gibraltar), that the bilious autumnal 
remittent is annually met with, and that cases of genuine Yellow 
Fever (as described by writers on diseases of the West Indies), 
accompanied by true black vomit, occur both in the Civil 
Hospital and in private habitations.' " 

And a little further on, in the same paragraph, he 
adds : — 

" ' It has been asserted, that these fevers are solely the produce 
of the Neutral Ground and the Lighters in the bay ; but annual 
proofs subversive of this hypothesis are not only familiar,* but on 
record.' I can with confidence," continues Dr. Smith, add my 
own testimony to the truth of these observations. I have already 
this year (1830) seen three well-marked cases of sporadic Yellow 
Fever in the garrison, two of them with black vomit." 

Mr. P. Wilson, then on the half pay of the Army 
Medical Staff, and Surgeon to the Civil Hospital,f wrote 
to Dr. Chervin, on declining any further part in the 
investigations made in 1828-29, as follows : — 

I saw daily, more and more, the disposition and actual at- 
tempts to torture facts to the contagious side of the question ; and, 
therefore, as I could not submit to the idea of putting my name 
to papers officially drawn up in this partial way, I thought it best 
to withdraw myself entirely. 

" In candid inquiry I will go as far as any man, ability per- 
mitting, but to be led by one name, or another name, or for opinion, 
or for the prospect of gaining admission at preferment's gates, — 
no. Sir ! to such I shall never prostitute my independence.'* 

Persons who see disease only on a small scale, and who 
observe that within that small circle one attack is often 
followed by another in the same family, and that by a 
third, and so on, naturally believe that the second case is 
caused by the first, and the third by the second, and thus 



V * See Note, pp. 94, 95. 

t Now Surgeon to the Colonial Hospital, New Zealand. 



132 Necessity of extended and unprejudiced observation. 

refer the whole series of events to contagion. It is on 
this description of evidence that the entire structure of 
Quarantine is based. It is only when the facts as to the 
spread of disease on a large scale are examined ; when it 
is found that the same disease breaks out at the same 
time in different and distant towns, and in different and 
distant parts of the same town, and that wherever the 
disease rages, there invariably the localizing conditions 
are similar, that the first wrong impression is corrected, 
and a juster conclusion formed. The fault of persons in 
authority is, that they do not investigate the operation of 
causes in a w-ide field, and that they trust to the statements 
of quarantine officers, who are necessarily confined to a 
narrow view, and who are, moreover, biassed by their own 
peculiar interests against extending their sphere of obser- 
vation. The result is, that investigations on the question 
of importation and contagion have seldom been of such a 
searching character as to reveal the whole truth, and that 
several most valuable opportunities of settling the ques- 
tion have been lost. 

We submit as the general result of the preceding evi- 
dence, illustrative of the character, mode of propagation, 
and localizing conditions of Yellow Fever, the obvious 
conclusion that it is even less reasonable to expect that 
quarantine or sanitary cordons can have any real influence 
in arresting its progress, than it is to place confidence in 
such expedients in Epidemic Cholera. The following 
testimony borne by Dr. Davy to the uniform and signal 
failure of such measures in Yellow Fever, is in accord- 
ance with that expressed by every observer, with scarcely 
a single exception, who has been brought into extensive 
and practical acquaintance with the disease. 

" Of the Inspectors General of Hospitals who have served in the 
West Indies during the last 40 years, amongst whom the re- 
spected names of Sir Charles Ker, Dr. Jackson, and Dr. Fer- 
guson, are prominent, all have been persuaded that Yellow 
Fever, including many varieties or modifications, is of local origin, 
and is not propagated by contagion, with the exception of one, 
Mr. Green, who was a strict contagionist, and who, during the 
epidemic of 1819, a fever of wider range than is usual, acted 
accordingly, attempting even the enforcing of quarantine regu- 
lations, after the manner practised in the Mediterranean, where 



General Conclusions from the Evidence. 



133 



he had previously served and witnessed Plague. The vexatious 
and futile character of these measures are not yet forgotten in 
Barbados. Before entering on an undertaking of this kind, even 
supposing the disease to be guarded against to be contagious, it 
would be well to consider the extent to which it is practicable. 
If the doctrine of contagion be false, how many are the evils un- 
avoidable from the attempt to enforce quarantine : ihese are 
strongly exemplified in every account we have from eye witnesses 
of the Plague ; comprised in panic, desertion of the living, neglect 
of the dead; in brief, horrors on horrors, and even crimes on 
crimes." 

In our Third Report we propose to consider the 
decisions of the International Sanitary Conference which 
has just terminated its labours at Paris. In the mean 
time we may be permitted to observe that the extent of 
reform in quarantine against Yellow Fever proposed by the 
Conference, sufficiently demonstrates their opinion as to the 
excessive and needless severity of the present practices. 
This may be judged of by the fact, that before the Con- 
ference commenced their labours, all arrivals from coun- 
tries subject to Yellow Fever were put in quarantine in 
different ports of the Mediterranean, extending from 3 to 21 
days for passengers and ships, and varying from free pra- 
tique to 28 days quarantine on goods ; while it has been 
proposed to substitute for these irregular and excessive in- 
terruptions to commerce, a constant quarantine of from 
3 to 7 days for all arrivals on board of which no cases have 
occurred during the passage, and from 7 to 15 days when 
cases have occurred. They have proposed, moreover, that 
quarantine should cease when the disease has ceased. 

Even this mitigated quarantine, however, has been 
based chiefly on general assertions as to its utility, unsus- 
tained by any evidence ; the only cases which were 
brought prominently forward in proof of the importa- 
bility of Yellow Fever, and the consequent necessity for 
quarantine regulations, having been those cases which we 
have by anticipation examined and refuted in this Report. 

From a consideration of the whole oi the preceding 
evidence respecting Yellow Fever, we have arrived at the 
following conclusions : — 

1. Tiiat Yellow Fever Epidemics break out simul- 
taneously in different and distant towns, and in different 



134 



General Conclusions from the Evidence. 



and distant parts of the same town, often under circum- 
stances in which communication with infected persons is 
impossible. 

2. That Yellow Fever Epidemics are usually preceded 
by the occurrence of individual or sporadic cases of the 
disease, which sporadic cases are likewise common in sea- 
sons when no epidemic prevails. 

3. That Yellow Fever Epidemics, though occasionally 
extending over large tracts of country, are more frequently 
limited as to the space over which they spread, often not 
involving the whole of a town, and sometimes not even 
any considerable district of it. 

4. That Yellow FevTr Epidemics do not spread from 
district to district by any rule of gradual progression, 
but often ravage certain localities, while they spare entirely, 
or visit very lightly, others in the immediate neighbour- 
hood, with which the inhabitants are in constant intercom- 
munication. 

5. That Yellow Fever Epidemics, when they invade a 
district, do not spread from the houses first infected to 
the next, and thence to the adjoining, and thus extend as 
from a centre ; but, on the contrary, are often strictly 
confined to particular houses in a street, to particular 
houses on one side of a street, to particular rooms in the 
same house, and often even to particular rooms on the 
same story. 

6. That in general^ when Yellow Fever breaks out in 
a family, only one or two individuals are attacked ; com- 
monly the attendants on the sick escape ; and when 
several members of a family are successively attacked, or 
the attendants on the sick suffer, either the epidemic was 
general in the locality, or the individuals attacked had 
gone into an infected district. 

7. That when Yellow Fever is prevalent in a locality, 
the most rigid seclusion in that locality affords no pro- 
tection from the disease. 

8. That, on the other hand, so great is the success 
attending the removal Irom an infected locality, and the 
dispersion of the sick in a healthy district, that by this 
measure alone the further progress of an epidemic is often 
arrested at once. 

9. That such dispersion of the sick is followed by no 



General Conclusions from the Evidence, 135 



transmission of the disease, not even when the sick are 
placed in the wards of a hospital among patients labour- 
ing under other maladies. 

10. That no one of the preceding facts can be reconciled 
with any other conclusion than that, whatever may be 
the exciting cause of Yellow Fever, it is local or endemic 
in its origin : and the evidence of this conclusion is there- 
fore cumulative. 

11. That the conditions which influence the localiza- 
tion of Yellow Fever are known, definite, and, to a great 
extent, removable ; and are substantially the same as the 
localizing causes of Cholera and of all other epidemic 
diseases. 

12. That, as in the case of all other epidemic diseases, 
in proportion as these localizing causes are removed or 
diminished. Yellow Fever ceases to appear, or recurs at 
more distant intervals, and in milder forms. 

13. That besides the common external localizing: 
causes, there is one constitutional predisposing cause of 
paramount importance, namely, non-acclimatization — that 
is, the state of the system produced by residence in a cold 
climate ; in other words European blood exposed to the 
action of tropical heat ; the practical lesson being that the 
utmost care should be taken to prevent individuals or 
bodies of men, recently arrived within the Yellow Fever 
zone, from going into a district in which the disease 
actually exists or has recently been present. 

14. That there is no evidence to prove that Yellow 
Fever has ever been imported. 

15. That consequently the means of protection from 
Yellow Fever are not quarantine restrictions and sanitary 
cordons, but sanitary works and operations, having for 
their object the removal and prevention of the several 
localizing c.' iditions, and when such permanent works are 
impractical e, the temporary removal, as far as may be 
possible, o the population from the infected localities. 

We deem it our duty to state, in conclusion, that from 
the most careful examination which we have been able 
to make of the mass of evidence submitted to us from 
which the foregoing conclusions have been deduced, we 
have not found a single fact or observation clearly ascer- 



136 



Conclusion. 



tained and authentically recorded opposed to the general 
tenor of such endence. We have met with no exceptional 
cases. We have indeed found the opinions of some 
authorities, for whom we entertain great respect, not in 
accordance on some points, but these have reference for 
the most part to matters of a purely professional and 
scientific nature. On the great practical question, 
whether, whatever may be the nature and mode of pro- 
pagation of Yellow Fever, Quarantine and Sanitary 
Cordons can afford any real protection against its intro- 
duction and spread, we believe there is now a very general 
unanimity of opinion, in accordance with the evidence we 
have submitted, that they cannot. We believe there is 
the like general agreement in this further practical con- 
clusion that, the substitution of Sanitary or Hygienic 
measures, for Quarantine isolation and restriction, would 
afford more certain and effectual protection. 

We have received from recent inquiries much informa- 
tion with reference to the Plague of the Levant, the re- 
sults of which we propose to state in our Third Report ; 
results which appear to us to be of great practical value, 
as showing on the one hand what measures experience 
has proved to be inefficacious, and even mischievous ; and 
on the other hand, what measures may be resorted to 
with the best hope of preventing the outbreak, or arresting 
the progress of this formidable disease ; and thus of super- 
seding the necessity of those grievous interruptions to 
commerce, and international communication, which qua- 
rantine, so universally imposed on account of Plague, has 
hitherto occasioned. 

All which we humbly certify to Your Majesty. 

SHAFTESBURY. 
EDWIN CHADWICK 
T. SOUTHWOOD SMITH. 



Whitehall, 7 April 1852. 



[ 137 ] 



Appendix No. I. 

REPORT ON YELLOW FEVER. 
By Dr. Gillkrest. 

INTRODUCTION. 

London, 28th Oct., 1850, 

My Lords and Gentlemen, 

The wisdom of instituting a spirit of close investiga- 
tion in all matters connected with those diseases which, in an 
epidemic form, sweep away human beings in masses, has heen 
singularly exemplified throughout the country during the late 
prevalence of cholera ; for though great the afflictions lately 
experienced, the wisdom, energy, and humanity so promptly 
put forth were certainly the means of always mitigating, and, 
in numberless instances, of limiting this scourge, which other- 
wise would have produced results calamitous beyond calculation. 
Let us hope that the power which worked so well in the cause 
of truth on that occasion, may not rest in the belief that all 
has yet been done which the interests of humanity require. 

Contagion in Yellow Fever still remains to England a ques- 
tion of great national importance, on account of her colonies, — 
her commerce, — her fleets, — and her armies. 

Volumes have been written in various languages in support 
of the fallacy which annually consigns numbers of our fellow- 
beings to inevitable death. 

It will be seen from what f take the liberty of submitting in 
the following Report, how much humanity needs protection 
from opinions so erroneous and destructive. 

Great have been the efforts of many eminent men to disabuse 
the public mind on a question of such vital interest. But pre- 
eminent I may assert were the labours of the late Dr. Cliervin, 
of Paris, on this subject ; — respecting Avhom I beg to give the 
following extract from the Report of a Commission appointed 
by the Academy of Sciences in Paris, in 1827, to adjudge the 
Montyon prize designed for labours in medical science. Tlic 
Commissioners were MM. Portal, Boyer, Chaptal, Dumeril, 
Dulong, Gay-Lussac, de Blainville, Frederic Cuvier, and 
Magendie. 

The Report made by the above gentlemen, after stating 
some unusual steps taken by Dr. Chervin, to ascertain the con- 
tagious or non-contagious nature of tlicYoUow Fever at Giia- 

L 



138 



Report of Dr. Giilkrest. 



daloupe, to wliicK place lie liad proceeded from Paris, for tKe 
sole purpose of making investigations^ — proceeds tlins: — "Tliis 
is nothing! — It was, on tlie contrary, then, that Dr. Chervin 
conceived the wisest and vastest plan, that ever a medical man 
formed for the interests of humanity. 

It was no longer suf&cient for him, that he had satisfied 
himself that the Yellow Fever was not contagious in Guada- 
loupe ; it became necessary to ascertain whether it did not 
possess that character in other localities and in other latitudes 
and climates. It was. above all things, necessary to convince 
the Governments of Europe, so that commerce might be freed 
from unnecessary precautions, felt to be burthensome, and that 
nations might be saved great expense in sanitary establishments. 
In attaining his object, Dr. Chervin was only impelled by his 
ardent philanthropy — no other .means, but the sacrifice of his 
patrimony — no support, but his own inclination and physical 
powers — let it be declared, to the honour of humanity, that by 
such means alone, enterprises of this kind could be accomplished; 
and in fact, what a powerful Government could scarcely hope 
to obtain at great expense. Dr. Chervin proposed to himself to 
obtain. 

Dr. Chervin performed this gigantic undertaking, to which 
the history of medicine furnishes no parallel, in a fortunate 
manner, but with unheard of efibrts, and perseverance above 
all praise." 

Speaking of his having collected the evidence of hundreds of 
medical men in all parts of the world, where the Yellow Fever 
is known to prevail, the Report continues — 

" He visited, in eight years, all the Colonies belonging to 
France, England, Spain, Holland, Denmark, Sweden; — he 
visited all parts of JNorth America, where the -Yellow Fever 
had shown itself, from New Orleans to Portland, in the state of 
Maine ; — so that from Cayenne to this last place,, he traversed 
over and made investigations in 37 degrees of latitude." 

" It [the Commission] therefore proposes to adjudge him a 
prize of 10,000 francs ; undoubtedly a poor reward for the many 
sacrifices which he must have made ; but when a person has, 
like Dr. Chervin, merited so much from science and humanity, 
and shown such disinterestedness, on voit la Couronne et non pas 
sa vaJeury 

Strongly as I believe that many have been unreasonably 
biassed in their opinions as to the contagious nature of Yellow 
Fever, yet I most readily admit that others, among whom are 
some of my personal friends, have been misled by the seirhlance 
of contagion, so frequently occurring, and by their insuj^icient 
investigation of all the circumstances connected with the 
subject. 

Indeed, I think from what will be found in the followincf 



On the Yelloiu Fever. 



139 



pages, that this disease would seem to require a very special 
study as to its nature and the phenomena it presents. 

Those who have laboured with me in my investigations can, 
I trust, speak as to the good faith with which those labours 
liave been conducted. 

In conclusion, allow me to entertain the hope that what I 
have here submitted, under the sanction of your honourable 
Board, as a bequest to my country, will tend, in some degree, 
to excite the attention of Her Majesty's Government, and of the 
Legislature, to a more efficient investigation of the subject ; — 
and that the same humane as well as energetic steps which, in 
so timely a manner, crushed the head of the hydra Con- 
tagion " in Cholera, — will no longer suffer a system, to have 
sway which continually places at the mercy of persons pre- 
judiced, or deeply interested, or little acquainted with the 
subject, the mighty question of the lives of large portions of 
our naval and military forces in various parts of the world. 
I have the honour to be, 

My Lords and Gentlemen, 

Your obedient Servant, 

J. GiLLKREST, M.D. 
Inspector-General of Army Hospitals, and Corresponding 
Member of the Paris National Academy of Medicine, 

To the General Board of Health. 



REPORT. 

I HAVE taken upon me the very onerous task of writing on 
Yellow Fever, which, in its malignant form, has swept off" 
numberless human beings in the West Indies, North and South 
America, various parts of the coast of Africa and adjacent 
islands, as well as Gibraltar, and several places in Spain ; once 
in Lisbon (1723), and once in Leghorn (IS04.) 

I cannot better convey an idea of the difficulty of my under- 
taking than, by quoting from the French Academician Moreau 
De Jonnes,'"^ 1820: — "Several powerful causes have contri- 
buted to render Yellow Fever a disease of which the origin is 
uncertain, the cause unknown, the character equivocal, and the 
consequences so terrible, that we are equally at a loss to dis- 
cover the means of preventing it, of checking it, or of 
treating it." 

With certain modifications regarding the checking of the 
disease, and perhaps also as to its treatment, unless, indeed, in 
the form the most malignant of all — I fully agree in the pro- 

* A man of science, formerly a military man. who, sinoe his service at Mar- 
tinique in 1802, as aide-de-camp, has figured a good deal in the discussions relative 
to the contap;ion of yellow fever, as well as spasmodic cholera, though not of the 
medical profession. 

L 2 



140 



Nomenclature of the Disease. 



prlety of what is here said, being conformable to my great 
experience, aided by laborious researches in the course of a 
long life. — I cannot admit that it has not often been prevented 
or checked by change of station. 

NAMES GIVEN TO THIS DISEASE. 

The Academician already mentioned, has enumerated no 
fewer than 36 names for the disease in different languages, of 
which it may be sufficient to mention the following : " Yellow 
fever," " Black Vomit fever," Bulam fever," " Fi?vre jaune," 
" Vomito negro," &c. Some have adhered to Bilious Remit- 
tent, others have called it Pestilential, from its ravages, and a 
late writer denominates it the " Hasmagastric Pestilence," 
from a single symptom which, however, is far from constant. 

The anomalies which this disease has been observed to pre- 
sent, — the absence, under the observation of one medical man, 
of some of the symptoms which, during another epidemic, had 
been well marked, — the fact of practitioners having observed 
that certain symptoms, prominent during one period of an 
epidemic, have at another period, been totally absent ; the fact, 
too, of patients in the same ward of an hospital, being found 
to labour under symptoms so variously grouped as to lead an 
inexperienced practitioner to believe that he had before him 
three or four diseases bearing little affinity to each other; — all 
these circumstances have thrown difficulties in the way of this 
disease having had a place assigned to it in nosological arrange- 
ments, free from objections. 

By some. Yellow Fever has been classed with continued fevers, 
the symptoms not having appeared to them to correspond with 
those laid down by nosologists as characterizing remittents ; 
while, according to the statements of others, of whose accuracy 
of observation there cannot be a doubt, the disease has assumed 
the most unequivocal remittent form : indeed, there is very 
respectable evidence in proof of its having, on some rare 
occasions, assumed even the character of an intermittent. 

This is not the place to define what constitutes, rigorously, 
remittent fever ; it is plain that in most countries the opinions 
of medical men are at variance upon the subject. The remarks 
of close observers go to prove how frequently remittents may 
be masked so as to mislead as to their true character. 

The great Italian medical authority Tomassini says on the 
subject of classing diseases : — 

Tant il est vrai que I'entreprise de classer les maladies a 
souvent entraine dans des contradictions les auteurs les plus 
eclaires."* 



Tomassini's Hesearches on Yellow Feverj p. 24. 



Remittent Type. 



141 



Let us listen to wLat the experience of Dr. EUiotson, of St. 
Thomas's Hospital, had taught him on the subject of remit- 
tents : — 

Remittent fever will frequently occur insidiously, and, 
unless you are quite up to it, you may as easily pass it over as 
some forms of epilepsy. I have had many cases of remittent 
fever, which, in addition to the symptoms of continued fever, 
were merely characterized by excessive sweating." — London 
Medical Gazette, January 3, 1831. 

Those therefore cannot, with justice, be accused of much 
inaccuracy who, confining themselves probably to their own 
field of observation, have looked upon Yellow Fever as belong- 
ing to the class of continued fevers ; but it is important to 
show whether those are right who maintain that the disease 
bears no affinity whatever to remittents, and that it never 
assumes any other than the continued form. 

On this point it will be right to quote authorities of respect- 
ability. Dr. Rush, in his account of the epidemics at Phila- 
delphia in 1793 and 1794, distinctly notices remissions in 
several pages: — The remissions were more evident in this 
than in the common bilious fever. They generally occurred 
in the afternoon."* " It," speaking of delirium, alternated 
in some cases with the exacerbations and remissions of the 
fever.' 'f Speaking of the second form of this fever, he says 
that it was attended '' with obvious remissions. "J At p. 45 of 
his account of the epidemic of 1794, he says that the disease 
"appeared most frequently in the form of a remittent. The 
exacerbations occurred most commonly in the evening." In 
another passage, often quoted, Never has the unity of our 
autumnal fever been more clearly demonstrated than in our 
present epidemic. Its principal grades, viz., the intermittent, 
the mild remittent, the inflammatory bilious fever, and the 
malignant Yellow Fever, have all run into each other in many 
instances. A tertian has ended in death with black vomiting, 
and a fever, with the face and eyes suffused with blood, has 
ended in a quotidian which has yielded to a few doses of 
bark."§ 

Dr. John Hunter in his Observations on the Diseases of the 
Army in Jamaica, 1796, p. 62, says, " The fevers that prevail 
m Jamaica are either of the intermittent or remittent kind. 
The remittent fevers are both the most frequent and the most 
fatal." At p. 63 he describes the ordinary symptoms ; and at 
p. 318 he says, " When the remittent fever is of the worst 
kind the yellowness of the skin occurs most frequently ; but 



* Account of Epidemic of 1793, p. 79. 
t Op. cit,, p. 62. 
X Ibid., p. 82. 

§ Letter to Dr. Miller, New York Medical Repositoi-y, vol. vi., p. 249. 



142 



Authorities in supjWTt 



the Yellow Fever is neitlier a different disease, nor do all tlie 
sick, even in fatal cases, turn yellow ; yet, at such times, it has 
been customary to call the prevailing fever by the name of the 
Yelloiu Fever 

In some observations on Yellow Fever by Staff Sursfeon 
Nodes Dickenson (Med. Chir. Jour. Vol. ii., 1820, p. 190—1,) 
we have the following r-^ — 

" Feelings of heat and slight clilliness alternate for a time."" 
The truth seems to be that the morbid actions constituting 
Yellow Fever are marked by almost inconceivable rapidity,, 
and the duration of the cold stage is proportionably evanescent ;, 
but generally not the less real; though, from occurring in the 
night, it is often unnoticed by the patient, and at so early a 
period, it is seldom observed by the practitioner. 

" In the situation of most of the West India sea ports, the 
continued form is most frequently observed. But we have 
often remarked that the same exposure and irregularities ex- 
ercised in places notoriously abounding with marshy effluvia 
(as the towns of Point a Pitre, Guadaloupe, Fort Royal, in 
Martinique) have been succeeded by the recurrent character 
of attack." 

Mr. Campbell, of the army medical department, in an official 
report dated Montserrat, 1825, gives as his reasons for thinking 
that the remittents, &c. of the West Indies are grades of the 
same disease— that, during a yellow-fever epidemic at Bar- 
badoes in 1821, he observed, " the most marked difference in the 
type and symptoms of cases of patients from the same barrack 
or hut, where not the slightest doubt could be entertained of 
the disease being produced in both instances by one and the 
same morbific cause, yet so modified by physical causes, con- 
nected with the patient, as to appear quite different diseases^ 
and certainly requiring different modes of treatment.'* 

The frequent occurrence of Yellow Fever in Spain, entitles 
the statements of the medical men of that country to great 
consideration on the point in question. The late Dr. Arejula, 
who was so familiar with Yellow Fever as it appeared in Spain 
within the last half century (having been appointed by the 
Spanish Government to visit and report upon various epidemics 
prevalent in the different provinces, 1803-4), repeatedly 
informed the writer of this Report that the disease frequently 
assumed the most marked remittent form. In his descrip- 
tion of the Malaga epidemic of 1803,* he tells us that the 
bark was found useful during the remissions. At p. 71 he 
is clear on the subject of remissions; and at p. 139 informs 
us that the disease ^' without doubt deserves the name of 
remittent fever."! He even says, when describing a black-vomit 

* See his work on Yellow Fever, p. 25. 

t " Merece sin duda el nombre de calentura remitente." 



of Remittent Type. 



143 



epidemic, the termination of our remittent m intermittent, 
which also occurred in some instances at the close of the epi- 
demic, was an indication that the disease was about to be 
extinguished." 

The recorded opinions of Dr. Velasquez of Seville^ are fully 
in corroboration of the statements of Arejula. The following 
physicians were contemporaries of the latter gentleman, and 
had witnessed some of the Yellow-Fever epidemics of Spain ; 
Dr. Balmis, who called the disease, as it presented itself during 
the Cadiz epidemic of 1800, *'a putrid malignant remittent;'* 
Dr. Flores Moreno, who describes in his work accessions and 
remissions;" Dr. Alfonso de Maria of Cadiz, says, when the 
yellow fever degenerated into intermittent." In the third 
volume of Hurtado's Decadas, published at Madrid, may be 
found a memoir relative to one of the Seville epidemics, with 
the signatures attached of Drs. Gabriel Rodriguez, Serafin, 
Adame, Velasquez, and Chicon, to the effect that " sometimes, 
though rarely, the fever presented itself following the type of 
an intermittent."* In the Trozos ineditos of Dr. Salva, professor 
of medicine at Barcelona, evidence is to be found of the disease 
having been observed to assume the remittent form. 

It may be stated that the records of the Gibraltar Yellow- 
Fever epidemics furnish the following names in support of 
the fact that remissions not unfrequently take place in this 
disease : Drs. M'Mullin and Browne, Messrs. Sproule, Wild, 
Martindale, Amiel, Dow, Dennett, Humphries, Lee, and Hugh 
Fraser. 

For myself, the ordinary characters of remission did not so 
appear in 1828 as to warrant my speaking decidedly on the 
subject. If we keep in mind the quotation I have given from 
Dr. Elliotson as to the characters of remissions being often in- 
sidious, and easily escaping notice; and if, also, it be con- 
sidered that my regiment (43rd) had been more severely and at 
an earlier period attacked than any other in the garrison, the 
pressing wants of the sick might well account for such light 
and evanescent symptoms passing unobserved. 

But however lawful it might have been in the midst of clash- 
ing opinions to doubt the existence of Yellow Fever in a re- 
mittent shape, late authorities in some of the French West 
India islands, and in the United States, have placed the 
matter so entirely in the affirmative, that there is no longer 
room for cavilling on the subject. The evidence, indeed, is 
so overwhelming, that, extremely reluctant as I am to heap 
evidence on what is already proved, I cannot forbear referring 
to the following, the importance of which will be duly appre- 
ciated by the profession. 



* " Alguna Yez. aunque rara, se presenta la calentura siguiendo el tipo de 
intermiitente." 



114 



Remittent Tyj;e. 



I would especially 'call attention to two memoirs by Dr. Rufz, 
Paris, 184*2, on the Yellow Fever epidemic of St. Pierre, Mar- 
tinique, prevalent from 1838 to 1841. 

I mast confine myself to the statement, page 33, of his 
having' "seen no C2ises favourable to contagion — also, page 57, 
that from September 1839 to the end of December 1840, the 
epidemic at St. Pierre, in the greater number of cases, assumed 
an intermittent or remittent form, " Men pjwioncee^ The sul- 
phate of quinine employed in such cases, appears to have 
been efficacious. 

He states that the surgeon of the frigate " Herminie,^^ treated, 
in September 1838, at Vera Cruz, above 100 cases of intermit- 
tent " vomitor I would refer the profession at large to these 
memoirs, in which will be found superabundant proofs of the 
relationship between the Yellow Fever and the •periodical forms 
of fever. 

The Reporters, Drs. Londe and Chervin, refer also to the me- 
moir of Dr. Dutroulau on the subject of a similar epidemic at 
Fort Royal, Martinique, with well-marked remissions. 

M. Bertulus, in his Memoir on the Importation of Yellow 
Fever into Europe, says (p. 66) : " These symptoms " \i. e. 
general] continued from twenty-four to thirty-six hours, 
sometimes even longer, and were accompanied by an extra- 
ordinary alteration of the countenance ; then true paroxysms 
of pernicious intermittent fever speedily appeared, and their 
stages, though at times sufficiently distinct, in the great majo- 
rity of the cases ran into each other; these paroxysms succeeded 
one another with such rapidity, that it was really impossible to 
detect the moment of intermission, which was looked for with 
impatience, in order to administer the sulphate of quinine." 

A work published by Dr. Bartlett, Professor of Medicine, 
of Transylvania College {PhiV^, 1847), on the history, diagnosis, 
and treatment of the fevers of the United States, is full of 
information on the subject, and must henceforth be appealed 
to by all who desire information on the Yellow Fever. We 
are there told (what indeed was always plain enough) that 
the best description of periodical fevers is not to be learnt in 
England, where, in fact, the ''pernicious forms'^ so fully de- 
tailed by Torti, Ramazzini, Baglivi, Lancisi, and other old 
Italian writers, are not to be found in the experience of prac- 
titioners. 

Amidst the great variety of information on the subject of 
American fevers. Dr. Bartlett, refers to the following, from a 
paper by Dr. Lewis, of Mobile, who attended during the epi- 
demic of 1843 cases in the southern part of the city, where the 
remittent fever prevailed extensively both among the natives 
and acclimated. Dr. Lewis describes a form of disease which he 
calls remittent and intermittent Yellow Fever,, and tells us that 



Ahjid Cases of the Disease. 



145 



1 6 cases of remittent* or intermittent fever assumed the rank and 
grade of Yellow Fever, and that these cases were all amongst the 
unacclimated. He estimates the number of cases during that 
epidemic (1843), at 100, 50 of which proved fatal. 

Among the variety of forms shown by Dr. Bartlett to be as- 
sumed by the periodical fevers of America, we find (p. 354) the 

algid variety," which was observed by myself and others in 
the epidemic at Gibraltar in 1828, and many years ago touched 
upon by me in writings published in England! and France, 
in the following terms: — "The patient, although in possession 
of his faculties, lies for the most part on his back, in a state of 
collapse, his limbs pulseless, clammy, and stricken with a degree 
of coldness considerably below that which is found to take place 
in a corpse under similar atmospheric temperature ; while pro- 
bably he complains of agonizing internal heat, and casts off the 
bedclothes incessantly." Still stronger, however, is the follow- 
ing quotation from a manuscript drawn up by me in the hospital 
surgery, on the termination of the epidemic ; drawn up to the 
knowledge of every regimental medical officer present, all being 
invited to point out any errors in my statements respecting 
their particular corps : "Singultus," I state, "in a severe degree 
may now be looked for ; the pulse can no longer be felt at the 
wrists, the extremities become almost as cold as marble in 
winter, indeed, many degrees colder than any substance which 
one can lay his hand upon at the time, or than the same parts 
are when life becomes extinct. This coldness, with a remark- 
able clammy feel at the same time, conveys a peculiar shock to 
those who apply the hand to the limbs." 

Among other algid cases witnessed in the garrison, were two 
of a very remarkable nature, which appeared in the hospital 
of the 42nd regiment, then, on account of the illness of assistant 
surgeon McGregor, under medical charge of Mr. George Brown,:|: 
assistant surgeon 43rd regiment, who requested me to visit 
these patients in company with himself. 

This gentleman has lately confirmed my strong expressions on 
these cases. Hie very mention of them, even at this distance of 
time, seems to occasion a most painful impression on his feel- 
ings. In one of them he speaks of " the shock conveyed by the 
intense coldness of the patient's body, — of the pulselessness, — the 
broken voice, as in algid cholera, — the perfect soundness of mind 
and readiness to reply rationally to all questions, — whilst, to his 
utter astonishment, the body was pale as the whitest marble — 
so that, on the whole, an appearance was presented quite 
"beyond anything" which he had ever before or since wit- 



* See also Thomas de la Fievre Jaime, p. 35. 

t Cyc. Prac. Med. (1833), Art. Yellow Fever ; where the general symptoms and 
morbid appearances of the disease are detailed. It is therefore unnecessary that I 
should repeat them here. 

X Now surgeon of the Grenadier Guards. 



146 



General History 



nessed. Mr. Brown thinks the patient lived two days in this 
state. 

In his second case the symptoms were very similar, with the 
exception of the extreme paleness, instead of which there existed 
a tendency to a certain livid or leaden colour, * especially of and 
about the ears, this being indeed the most common appearance 
presented in our algid cases during that epidemic, t 

Mr. Brown assures me that, after every consideration he feels 
convinced that the term algid" is here perfectly applicable; 
and that the change to this state was sudden, as noticed by 
Maillot, who also observes that these algid symptoms are exclu- 
sively peculiar to fevers of a periodic type. 

Having last year been in contact with Dr. Jameson, staff 
surgeon, who has had much experience in West Indian fever, 
that gentleman writes me to the following effect : — " During 
my residence in Jamaica, from 1834 to 1845, 1 have seen several 
cases of the algid variety of Yellow Fever." He also states that 
he witnessed recovery in one ''case of algid variety of Yellow 
Fever, successfully treated by quinine at Kingston^ Jamaica, 
about 1843-4 — serjeant McHugh, then of 60th, afterwards 48th, 
now, I believe, an officer in a West India regiment : quantity 
given during the whole attack exceeded 700 grains." 

I am of opinion that if Yellow Fever epidemics can be always 
closely investigated, algid cases are likely to be found much 
oftener than may be supposed ; for I find, on consulting Are- 
jula on the epidemics of Spain, that he frequently speaks of 
this cold "variety of the disease. — See p. 168, where he mentions 
the marble coldness elfrio marmored'^), also pp. 160, 173, 259, 
and several others. 

Dr. Lafuente in reference to the cold variety of Yellow Fever 
in Spain, gives symptoms of a sufficiently unmistakeable cha- 
racter in his account of what occurred at Medina-Sidonia in 
1801. At page 28 h and 28c, we find the word "■h'pirico'' and 

lipiricos^^ employed ; which, if rendered Lijjyria,'" will bring 
us to the precise word employed by the most ancient authors on 
fever, in which privation of heat was a leading feature ; after- 
wards employed by Torti, and recognized by Cullen. 

HISTORY OF THE DISEASE. 

Previous to entering into details, it may be stated that a dis- 
ease is here understood in which, along with other symptoms, 
yellowness of the skin, partial or general (though by no means 
constant), and, towards the fatal termination, vomiting of a 
black or dark-brown fluid, still less constant, occur. As it will 
be necessary to refer frequently to the yellow-fever epidemics 
of Spain, and as, notwithstanding all that has been written 



* This appearance mentioned as occurring at Cadiz, 1800. Arejula, p. 172. 
t Cases of this kind had been noticed in previous years by Dr. Bobadilla. 



of Yellow Fever. 



147 



upon tlie subject, tlie identity of yellow fever, in that country 
with the black-vomit fever of the West Indies, North and South 
America, has been denied, so late as 1828, by a French phy- 
sician (Dr. Rochoux), who went to investigate the Barcelona 
epidemic of 1821, it may be proper here to premise that the 
•perfect identity " of the disease has been admitted* to have been 
established beyond all doubt at Gibraltar in 1 828. 

Among writers on Yellow Fever, the names of respectable 
men will be found who maintain that this disease has made its 
appearance on the continent of America, in the West India 
islands, and certain parts of Europe, in modern times only. In 
opposition to this it has been shown, that though in former ages 
this disease may not have been observed to prevail epidemically 
in that part of the neighbourhood of the Mediterranean where 
Hippocrates practised, it is not the less true that this close 
observer had been familiar with a fever in which the two symp- 
toms considered by most writers as characterizing the disease 
(yellowness of skin and black vomit) were sometimes present. 

We are reminded by Humboldt that the period of the first 
description of a disease furnishes no evidence of its having 
only then for the first time appeared ; and the ensemble of 
the symptoms of Yellow Fever being only to be found fully 
and accurately detailed by writers of the last century, will 
scarcely be considered as furnishing conclusive evidence of 
the non-existence of similar epidemics at periods more remote. 
'Owing to the state of medicine in former ages, and to the 
fact of practitioners having been so few that the sick were 
not unfrequently wholly destitute of medical aid, the exact 
nature of many epidemics which reigned from time to time, 
under the names of "pest," ''pestilential disease," black 
death,'' ''yellow death," &c., has not been handed down to us. 
We have a remarkable proof of this in epidemics which 
prevailed in this country formerly, under the name of "sweat- 
ing sickness;" the accounts of that disease being quite un- 
satisfactory. To admit that all ancient epidemics within 
certain parallels of latitude, and termed pests or plagues, were 
of the character of true plague, while all the epidemic fevers 
of modern times, which have so frequently afflicted the inha- 
bitants of the same latitudes, have not possessed the characters 
of plague, but those of Yellow Fever, would be admitting what 
is but little conformable to the usual course of nature. Pere 
Dutertre, one of the oldest writers on the Yellow Fever of the 
West Indies, employs the term peste,''' when detailing symp- 
toms not corresponding with those of plague, but such as pecu- 
liarly belong to Yellow Fever. 

* Vide BuUefin des Sciences Medicales, vol. xviii. p. 90 (1829). This identity 
seems to have been placed beyond all doubt by my having shown that we had, 
occasionally, at Gibraltar, the same kind of hsemorrhagic depots or tumours which 
Dr. Keraudren and others had noticed in the Yellow Fever of the West Indies. 



148 



Alleged Importation from Africa 



To give even a partial view of the arguments employed Lj 
various British writers in support of and against the statement 
of the Yellow Fever having been imported into the West India 
islands for the first time in 1793, would occupy more space 
than could with any propriety be devoted to the point. Its 
importation into the island of Grenada in that year rested 
chiefly on the authority of the late Dr. Chisholm, who be- 
lieved that he had traced the origin of the fever to the ship 
" Hankey," which had lately arrived from the island of Bulam, 
situated on the west coast of Africa. This statement of the im- 
portation into the West Indies of a " nova pestisy' as it was then 
called, has since given rise to much controversy ; but those who 
consult Bancroft's Essay on Yellow Fever, and a small treatise on 
the disease published in 1818 by Dr. James Veitch, an expe- 
rienced naval surgeon, will find details of a very interesting 
nature, which go to prove that on this occasion Dr. Chisholm 
had certainly proceeded on very erroneous data. 

Respecting the alleged importation of the disease into 
Grenada by the " Hankey," I must refer to the observations of 
Dr. Cragie, of Edinburgh. This distinguished physician states 
to the following eftect in his "Practice of Physic T vol. i. 

" Dr. Chisholm maintained that the disease thus generated 
and imported was a new pestilential disease, unheard of before 
in the West Indies, entirely different from Yellow Fever and 
malignant pestilential fever; he specially applied the name 
of Bulam to it. The whole of this, however, originated in 
mis-statements of facts, and complete ignorance of the previous 
history of the West India fever. 

" It may therefore be regarded as certain, that the disease 
which was thus, by a degree of ignorance and misapprehension 
almost unrivalled in the history of medicine, then and since 
denominated Bulam fever, was only the usual form of fever 
common, in certain seasons, to the whole of the West India 
islands, and whicli has prevailed there, chiefly among the 
newly-arrived or not long-resident Europeans, ever since com- 
mercial intercourse has been fully established between Europe 
and these islands." And, truly, it was unpardonable for Dr. 
Chisholm and his followers to apply the term " Nova pestis'* to 
a disease long before distinctly recorded by a celebrated noso- 
logist, Sauvage, and other writers, who should have been con- 
sulted. Without referring to old Spanish and French authors, 
Drs. Chisholm and Pym might have found, from at least the 
following writers, that there was nothing new in the matter : — 
Town, 1736; Lining, 1758; Hillary, 1766; Mackittrick, 1766; 
Lind, 1772; Hunter, 1788;* Moseley, 1790. 



* Sir W. Pym states, p. 51, second edition of his work, that the health of Jamaica 
previous to the arrival of the " Hankey " was good, and (among other authorities, 
all of whom are referred to in regard to periods subsequent to that about to be 



into the West Indies. 



149 



Pere Dutertre would seem to be the first by whom details 
of the symptoms and progress of this disease in the West 
India islands have been transmitted to us.* From the re- 
markable muscular pains often felt by a patient labouring 
under an attack, as if from heavy blows, it was then called 
couj) de harre ; and Pere Dutertre, considering it a new disease 
when he first saw it (1635), termed it "the pest unknown pre- 
viously in these islands." He notices the yellowness of the 
skin particularly ; and though he says that the disease was im- 
ported into the islands by "some ships," and in another page by 
a particular ship, " Le BcBuf," from Rochelle, he says that 
those " were chiefly attacked who were employed in clearing 
the land in different islands, and were exposed to the poisonous 
vapours and exhalations." t 

Pere Labat, on landing at Martinique in 1649, found the 
disease raging in that island, and the monks belonging to the 
convent of his order suffered severely. He tells us that he 
himself had the disease twice ; that people were frequently 
attacked so suddenly and severely that they fell down in the 
streets ; that haemorrhages from the several natural orifices, 
and even from the skin occurred ; and that the disease usually 
proved fatal within five, or six days. He states that the 



mentioned) quotes (p. 55) Dr. Hunter, respecting the salubrity of Fort Augusta and 
Stony Hill in 1781-2, in proof of his assertion. 

On consulting " Observations on the Diseases of the Army in Jamaica," &c., by 
John Hunter, M.D., Loudon, 1796, pp, 26 and 27, we find it is indeed true that 
that \vriter speaks favourably of the two above-mentioned localities ; but they are 
expressly pointed out as exceptions, and by way of contrast with the sickly, 
nay deadly state, of other parts of the island during the period referred to, — which 
will abundanth^ appear from the following quotations 

At p. 11, Dr. Hunter says, " Four regiments were sent from England in 1780 to 
Jamaica ; they arrived there the 1st of August, and before the end of January 
ensuing, not quite six months, one-half of them nearly were dead, and a considerable 
part of the remainder were unfit for service." 

At p. 57, he says, " An average of the number of sick during three years and 
a half, in which are included the convalescents, gives one-third of the army unfit 
for service at the time of the greatest sickness, and one-eighth at the time of the 
least sickness. The average of deaths annually upon the whole is nearly one in 
four, and of discharged men about one in eight, which, together, makes the loss 
three-eighths of the whole. In less than four years there died in the island of 
Jamaica 3,500 men; those that were discharged amounted to one-half of that 
number, which make in all 5,250 men lost to the service in that short period of time 
from the climate and other causes of mortality, without a man dying by the hands 
of the enemy." 

Speaking of the symptoms of the disease, p. 64, he says, " The vomiting is some- 
times constant and violent, especially in the worst kind of the disease, and the 
blood being frequently in a dissolved state is forced into the stomach and thrown 
up, forming, what has been called by the Spaniards, the black vomit." 

Is it then credible that with this book before bim the British Superintendent 
of Quarantine should write the following, at p. 59 of his second edition ? 

" These quotations, from the highest authority, prove that for several years before 
1793 there was no instance of that species of disease prevailing epidemically in 
the West Indies, which is characterized by black vomiting," &c. 

* Histoire Gene'rale des Antilles. 

f Ibid., p. 81, ed. in 4to. 



150 



Early Prevalence at St. Domingo. 



disease was called rnaladie de Siam, from the belief of its 
liaving been imported into Martinique bj a sbip of war, the 
"Oriflamme," "Avliicli, coming from Siam with the remains of - 
the hospital establishments which had been at Mergay and^ 
Bancock, touched at Brazil, Avhere she became infected with the 
disease which reigned there for seven or eight years. '* This 
account of the introduction of the disease into Martinique 
relates to the year 1688, being some years before his arrival 
in that island; and his statement would seem to rest altogether 
on the belief then prevalent as to the circumstances. 

At page 337 of Dr. Bancroft's Essay on Yellow Fever, we 
have evidence of the existence of the disease at St. Domingo 
in the year 173) ; and, in subsequent pages, of its having pre- 
vailed there epidemically in 1733, 1734, 1739, 1740, 1741, and 
1743. 

The insalubrity of that island was manifested soon after its 
discovery ; for it appears that the sickness among his men gave 
Columbus great anxiety. It could scarcely have been expected 
that anything very precise as to the nature of the disease from 
which they suffered should have been transmitted to us. A 
late historian, Washington Irving, merely informs us that 
" when they fell ill their case soon became hopeless." Reason- 
able inferences may however be drawn from passages in old 
Spanish historians. Oviedo, in his Historia General de las 
Indias,'\ speaks of a great mortality among Columbus's people 
in 1494, which he attributes to the humidity of the island. 
He says that those who returned to Spain were of a yellow or 
saffron colour that people finding the country feo unhealthy 
objected to go there ; J and that in consequence 300 convicts 
were at one, time sent to St. Domingo. He adds, that if the 
kino- offered him the Indies he would not cro there. M. Moreau 
de Jonnes cites § one or two other jDassages from Oviedo on 
the same subject, which I have not been able to verify by a 
reference to the edition within my reach. Further details are 
given by Herrera (Madrid 1601), as to the violence, sudden- 
ness of attack, &c., of the disease which carried off so many of 
Columbus's men in St. Domingo; and he refers to a letter || 
written in 1498 by Columbus to the king of Spain, attributing 
the sickness of his men on their first arrival to peculiarities in 
the air and water. 

Respecting the accounts of the existence of the Yellow Fever 
at remote periods on the American Continent, it would appear 
that Dr. Fournier Pascay, of Paris, who for several years 



* Nouveau Voyage aux lies de I'Ainerique, tome 1. 
t Ed. in folio 1547, book ii., cap. 13. 
X Rook iii., cap. 4. 
§ Monographic de la Fie'vre jaune. 
Book iii., c. 15. 



History of Epidemics in Spain * 



151 



devoted mucli attention to all questions connected with the 
disease, considers it identical with that referred to bj Ferreira 
da Rosa, in his account of Pernambuco, printed at Lisbon in 
1649. In the beginning of the last century the disease, from 
its appearance in various parts of Spanish America, under 
the name of vomito prieto, attracted much attention ; and it 
is particularly referred to by the historian Ulloa, who resided 
for some years in that country. The word prieto, it may be 
remarked, is the Portuguese or nearly obsolete Spanish term 
for black : in Spain the word net/ro is now universally substi- 
tuted. A small pamphlet of 62 pages, by a Dr. Gastelbondo, 
written at Carthagena (S.A.) in 1753, and printed at Madrid in 
1755, was probably the first work ex professo on the black-vomit 
fever, as it appeared in South America; he gives his expe- 
rience of the disease during 40 years; says, in the title-page, 
that he is about to write on a disease of frequent occurrence in 
that part of the world ; mentions change of climate and mode 
of living among the causes of the disease in new comers ; and 
says, that the natives of Carthagena, Vera- Cruz, &c., were not 
subject to attacks of the true black- vomit fever, though liable to 
the " clLapetonada,'' a disease resembling it in some respects. 

In North America the prevalence of Yellow Fever epidemic- 
ally, previous to 1793, seems unquestionable ; and authorities 
may be cited for its appearance at Boston in 1693; at Phila- 
delphia in 1695, 1741, 1751, and 1762 ; at Charlestown in 1695, 
1732, 1739, 1745, and 1768; at New York in 1702; and in 
Virginia in 1744. 

We come now to the history of Yellow Fever in that part of 
Europe where its frequent appearance, within the last half 
century, has so justly excited the attention of the profession, 
and of those governments who rank the investigation of such 
subjects among their first duties. Some writers (among whom 
was Sir Gilbert Blane) have stated that the first appearance of 
Yellow Fever in Spain was at Cadiz in 1764; next in 1800 in 
the same city ; and at Malaga, for the first time, in 1803. 

It seems strange that, with respect to Cadiz, those w^riters 
should have overlooked the remarkable epidemics at that place 
in the years 1730, 1731, and 1736, recorded by different 
authorities, the two first being very particularly noticed by 
Villalba, in his curious work " Epidemilogia Espanola'' It seems 
equally extraordinary that those writers should have over- 
looked the black-vomit epidemic which prevailed at Malaga in 
1741, described by Dr. Rexano, and since frequently referred 
to. With respect to epidemics which prevailed in Spain, 
previous to those of Cadiz and Malaga, many consider the 
evidence imperfect as to the disease having been, in any of 
them, sim-ilar in character to that under consideration; for 



152 



Spanish Yellow Fever Epidemics. 



in tlioie days all epidemics causing great mortality were called 
" pests," or " pestilential diseases." In epidemics called pests, 
recorded as having prevailed at Malaga in 1678 and 1679, two 
physicians, Drs. Checa and Molina, sent officially to inquire into 
the nature of the disease, pronounced it not plague. The writ- 
ings of Spanish medical men being but little known to the pro- 
fession at large, quotations from some of them on the present 
subject may be the more admissible. 

Dr. Hurtado, of Madrid,* adduces proofs in support of the pre- 
valence of the disease epidemically in former ages in Spain. He 
quotes Dr. Garcia Suelto as being of his opinion that such 
epidemics appeared at periods much more remote than 1730, 
and cites him as stating that the most distinguished men of 
the profession move as it were in a career new to them, but 
long known to Spaniards their countrymen. If the medical 
history of Spain had been more familiar to them they would 
have availed themselves of the excellent descriptions and im- 
portant illustrations to be found in the work of Antonio Fonseca, 
on the peste and contagious diseases, and on the epidemic fever 
of 1621." Hurtado also quotes Sebastian Nunez, Pablo Correa, 
Manuel de la Cerda, and others. 

The frequent application of the word atrahilis in ancient 
times to any dark fluid ejected from the stomach, tended, no 
doubt, to create obscurity as to the character of diseases ; and 
in Spain, medical men, for want of a better name, sometimes 
employed the words Jiebre dudosa (fever of a doubtful nature) 
when speaking of the epidemic disease. Escobar is quoted by 
Villalba respecting an epidemic which prevailed in Carthagena 
in the autumn of 1648; which was attributed to local causes. 
Escobar states that in his time the endemic fevers of Carthagena 
and Alicant sometimes became pestilential in the autumnal 
months. It appears from Villalba's work, that in 1648 other 
towns besides Carthagena, as Cadiz, Seville, Alicant, and Va- 
lencia, were afilicted by the epidemic; and it is remarkable 
that some of the writers of that period state that the disease 
was carried to the West Indies from one of those towns, from 
whence it was again brought back to Spain, and commenced 
fresh ravages at Barcelona, Gerona, Tortosa, and almost in 
every town in Catalonia." From this we may at least infer 
that the identity of the Spanish and West India diseases was 
then acknowledged. 

According to Villalba, three formidable epidemics took place 
in remote times at Barcelona within a period of eighteen years : 
one in 1497, another in 1501, and the third in 1515; and as 
they prevailed in the summer or autumnal months, their iden- 

* This Avriter, like many other medicos, was not at liberty, previous to tlie 
declaration of the constitution in Spain in 1821, to publish his opinions openly on 
these matters. 



Early Appearances at Gibraltar. 



153 



tity with the modern epidemics of Spain has been inferred. 
Villalba records an epidemic at Barcelona in 1589, which lasted 
from June to December — the deaths up to the 20th October 
having been 10,935. On this occasion the resident physicians 
of Barcelona maintained that the disease was not plague. 

A Dr. Porcel wrote, in 1565, on an epidemic which prevailed 
at Saragossa in the preceding year, and which ended in the 
month of December. He states that the symptoms were some- 
times very insidious ; that the patient seemed to be going on 
well, — pulse natural, skin temperate, &c. — till the fourth day, 
when the countenance became altered, and faintings took place, 
followed commonly by death : he adds that sleeplessness, ex- 
treme anxiety, (the patient rolling about the bed,) peculiar 
pain in the region of the stomach, and vomiting of a fluid 
(which he calls colera) of various shades of colour, took place. 
He notes, moreover, that the countenance became livid and 
yellow, (livido y amarillo.) 

The work of a Dr. Andosilla is also cited, in which he speaks 
of a disease under the name o^peste, which prevailed in some 
Spanish towns in the autumn of 1600. He visited those towns 
officially, and describes the disease as not having the characters 
of plague, but others ''new to him." In 1649, a Dr. Morillo, 
who had been employed at Marbella and other towns in Anda- 
lusia during an epidemic, went also to Gibraltar, to witness an 
epidemic, which, according to an old Spanish history of Gibral- 
tar, by Ayola, proved so fatal, that the people, losing all confi- 
dence in human means, instituted processions to the neighbour- 
ing hermitage of St. Roque, whi.ih were kept up annually in the 
month of August, till the surrender of the garrison to the British 
in 1704. 

There is a record of that garrison having, in the autumn of 
1727, lost 500 men by fever, but the character of the disease is 
not described. By a document in my possession from the late 
W. Hill, deputy inspector-general of hospitals, dated London, 
June 13, 1832, it appears that in 1798 the 48th regiment, 
arrived in Gibraltar from England, and that soon after, a severe 
fever appeared among the men, which carried off about 100 of 
them. This fever, which he says was confined to the recruits, of 
which there were great numbers, " Dr. Harness, then physician 
to^ Lord St. Vincent's fleet, and afterwards one of the com- 
missioners to the Sick and Hurt Board, declared to be pi-e- 
cisely the same he had seen in the West Indies^*^ In Trotter's 
Medicina Nautica it is stated that 257 deaths from fever took 
place in the above garrison in 1800, among the military; the 
average annual mortality among the military there having 
been only 38. 



* Addenda (A.), p. 206. 



M 



154 



Italy, Sicily, and East Indies. 



With respect to Gibraltar, therefore, these facts may be 
considered sufficient to establish that, previous to the Yellow 
Fever epidemic of 1804, the disease had made its appearance 
there to a formidable extent : indeed, it is well known that^ 
along that part of the Spanish coast, no other form of epidemic 
proves so fatal. It may be added, that Dr. Monro says in his 
work on the diseases of armies, that in 1799 a fever made its 
appearance at Gibraltar, which he considered similar to that of 
the West Indies. 

It is probable that the existence of the causes of Yellow 
Fever have not been confined to the localities in Spain re- 
corded as having been visited by the disease ; those causes 
may equally have been present, at numberless other places., 
though not recognised, in consequence of such places being 
uninhabited. We cannot always be sure of the existence of 
ague localities until the presence of inhabitants establish this. 

Respecting Yellow- Fever epidemics in other parts of Europe, 
that described by Palloni, Tomassini, and others, as having 
taken place at Leghorn in 1804, is the most remarkable. We 
have an account, by a Dr. Kennedy, of an epidemic at Lisbon 
in 1736 ; and, from the symptoms, there seems little reason to 
doubt of the identity of the disease with Yellow Fever. Pro- 
fessor Salva, of Barcelona, considers a fever with yellow skin 
which prevailed very extensively in a district of the Canton of 
Berne, during a period of very extraordinary heat, in the year 
1762, and of which there is some account in a volume of the 
proceedings of the French Academy of Sciences for 1763, as 
similar to the Yellow Fever of Spain. Some recognise this 
disease also in the fever with yellow skin, hsemorrhages, &c., 
described by Frank as occurring in Hungary. 

The existence of this fever occasionally at points higher up 
the Mediterranean than those already mentioned, rests upon 
respectable authority. The late Dr. Alexander, surgeon to 
H. M. forces, who had ample experience of Yellow Fever in 
the West Indies, declared to me on a particular occasion, that 
he witnessed many deaths from the disease in Sicily, soon 
after the return of Sir John Stewart's army from Lower 
Calabria in 1806; and that while at this latter place, some 
cases occurred among our troops. The existence of sporadic 
or scattered cases of Yellow Fever with black vomit even in 
England and France, has been insisted upon by some persons ; 
those referred to in the Dictionnaire de Medicine, vol. xxi. p. 17, 
as having occurred at Paris in the hot summer of 18'22, seem 
most worthy of attention. 

In turning to East India Records, the mention at p. 46 of the 
Bengal reports on cholera, of a fever with yellow skin which 
occurred in that presidency in 1816, can hardly be held as 
conclusive. But we find, in a memoir by Mr. Walsh, of the 



Spoj^adic Cases of the Disease. 



155 



medical department of our army during tlie Burmese war, that 
that gentleman, while in charge of cases of the fever prevalent 
in the army, was surprised by the sudden appearance of some 
with black vomit and yellow skin. It is recorded, as has been 
noticed by Dr. Johnson, in his work on tropical climates, that 
those symptoms appeared in a fever which prevailed in the 
hospitals at the Isle of Edam, appropriated for the sick of the 
force employed for the reduction of Java in 181 L 

At Sierra Leone this disease is recorded as having occurred, 
to a remarkable extent, in the year 1823. 

SPORADICS. 

Connected with the history of Yellow Fever, it is always 
considered a point of very great importance to ascertain whether 
it be a fact that, in those parts of the world where the disease 
is observed to prevail epidemically, single, or scattered, 
{'sporadic') cases have occurred in ordinary years. To the 
mass of evidence on this point, from the West Indies and 
America, not one word need be added in confirmation of the 
fact. In Europe a few only hold out against this statement ; 
in England, probably not more than two or three. But of late 
years so much attention has been paid to the subject that unless 
people be prepared to prove that symptoms, grouped together 
in a certain order, in conjunction with similar post-mortem ap- 
pearances, do not always constitute the same disease, it is quite 
idle longer to dispute the point. Among many other French 
physicians who have paid great attention to the subject of 
Yellow Fever, and who have recognised the existence of sporadic 
cases in Spain, are Drs. Pariset and Robert, leaders of the 
contagionists. In Spain we find Dr. Arejula, a leading con- 
tagionist, and Dr. Flores Moreno, also a contagionist, admit- 
ting it freely in their works ; besides Drs. Piguillem, Salva, 
and several other men of note. I am in possession of such a 
body of evidence, drawn from registers and other authentic 
sources at Gibraltar, as would of itself place the matter beyond 
all doubt. In the month of April, 18'29, the records of the civil 
hospital in'that garrison were examined at my suggestion, and 
a certificate drawn up and signed by nine gentlemen, to the 
following effect : — 

Gibraltar, ISth April, 1829. 

''We, the undersigned, have this day heard the foregoing 
thirty-nine cases, which have been extracted and condensed 
from the records of the Civil Hospital, carefully read over, and 
which have been compared with the original text. 

We are unanimously of opinion, that, with the exception of 
case No. 23 (Samuel Bird), they are identical with the cases of 

M 2 



156 Sporadic Cases at Gibraltar, 

the epidemic fever wKicK existed in ^tliis garrison during the 

latter part of the year 1828. 

(Signed) John Gillice, (a) 

Assistant Surgeon 12th Regiment. 

A. Browne, M.D. (e) 

Assistant Surgeon 23rd Regiment W. F. 
Edward Dow, (h) 

Acting Deputy Inspector of Hospitals. 

Hugh Fraser, (a) 

Surgeon of Civil Hospital. 

George Brown, («) 

Assistant Surgeon 43rd Regiment. 

J. Millar, {d) 

Assistant Staff Surgeon. 

J. GiLLKREST, M.D., {b) 

Surgeon 43rd Regiment. 

R. Amiel, (c) 

Surgeon 12th Regiment. 
Chervin, D.M. (/)" 

(a) The gentlemen marked thus had been here during the whole of the epi- 

(6) These gentlemen had witnessed epidemics in the West Indies, as well as at 
Gibraltar. , . 

(c) This ffentleman had witnessed three epidemics in Gibraltar, , , 

\d) This gentleman had seen the Yellow Fever, or Bulam of Dr. Pym, in the West 

^'^fe^^ This gentleman had seen the Yellow Fever at Gibraltar during a part of the 
epidemic season of 1S28. n my. ^ „ 

( f) Dr. Chervin had made the Yellow Fever his particular study for fifteen years 
previous to 1829, in various parts of the world, and had seen more Yellow I'ever 
than any per'^on then living. 

There is also evidence in a report drawn up for the Transport 
Board, by Dr Gray, formerly physician to the Mediterranean 
fleet, and for some years physician to the Naval Hospital, 
Gibraltar. After stating that remittents " (with dark stools, 
haemorrhage from the mouth, nose, &c.) are more or less 
endemic at Gibraltar, he says : — . 

" I have also observed, in some instances, matter ejected 
from the stomach, of a dark colour, resembling the grounds of 
coffee. During the long period of my ser\^ing, I cannot recall 
to my recollection a single instance of fevers being communi- 
cated from one person to another, either amongst the medical 
attendants or nurses." . j- • r a* 

And in a document (published in the second edition ot bir 
W. Burnett's work) by Staff-Surgeon Glasse, who had served ten 
years in Gibraltar, and witnessed the epidemics of 1804 and 
1813, as well as the cases of Yellow Fever which occurred m 
18 lo'. &c ; he says:— , -, t p 

During the autumn I have been m the habit ot seeing 
solitary cases of fever, attended with black vomiting and othei 
severe symptoms, both in the town and South'' (see plan T). 



Definition of Terms " Contagion^ and Infection.'' 157 



without the disease being commuuicated to others confined in 
the same building." 

In a letter to Sir James M'Grrigor, Dr. Thomas Smithy 
Surgeon, 23rd Kegiment, reports on a sporadic case of Yellow- 
Fever occurring in Gibraltar in March 1830; fearing that so 
marked a case might not otherwise obtain the attention of the 
Director-General of Hospitals in England. 

After detailing oth<3r symptoms, Dr. Smith expressly refers 
to the occurrence of the yellow skin and " black vomit :" also 
states that haemorrhages, suppression of urine, hiccough, dis- 
turbance of the cerebral functions with jactitation took place. 
The man died on the fourth day after admission. 

It is quite certain that for the last 20 years strongly marked 
sporadic cases of this disease have been of extremely rare 
occurrence at Gibraltar, while at the same time the existence 
of sporadic cases of true Yellow Fever wdthin that time even 
in London and Paris rests upon excellent authority. 

CONTAGION. 

Considering the misconceptions which so often arise regard- 
ing the words Infection and Contagion; I think it proper to 
explain the sense in which they are here used. 

In conformity, I believe, with the sense in which it is 
employed by medical writers in France, as well as in other 
continental nations, I mean by contagion, the power of com- 
municating disease, from the person of an individual labouring 
under it, to that of another, — whether by actual contact, — (the 
immediate contagion of the French) ; through the medium of 
linen, bedding, or any substance whatever ;* through the me- 
dium of the air, in a room in which an individual labours 
under the disease ; the capability of being propagated by 
means of excretions or exhalations from the bodies of those 
affected ; or, finally, by means of exhalations from the bodies of 
those who have died of it. 

The transmission of a disease in any of the above ways being 
clearly demonstrated ; its capability of subsequent extension, or 
general dissemination, may be reasonably contended for. 

By infection I w^ould be understood to mean, (as I also think 
the French do) a principle which produces the disease, depend- 
ing altogether upon local causes, and having no relation to ema- 
nations from persons labouring under the disease, or from the 
bodies of those who have died of it. 

Thus I would call a malaria spot, or filthy locality, 2. focus of 
infection. 

The discussions regarding the contagion or non-contagion of 
Yellow Fever have been of ancient origin, and are still con- 



* This and following are the mediate of the French and other authorities. 



158 



Yellow Fever at Gibraltar since 



tinued. Indeed invitations liave been held forth within the 
last few years, by writers who feel deeply interested in this 
important disease, that those who have had much experience on 
the subject, " should not allow it to remain in its present state." 

Gibraltar being in every way a station of high importance to 
the British Government, and my services there in responsible 
situations having extended over many years, I trust that my 
statements will be found given with all the care and all the 
fidelity which the importance of such a subject demands. 
The interest I have so long felt in everything connected with 
the health of that garrison, naturally induces me to give the 
Yellow Fever epidemics, which have broken out there, the first 
place in my consideration. 

The calamity of an epidemic at Gibraltar, afibrds greater 
facilities for the establishment of truth, as to its origin and 
progress, than perhaps any other place whatever. 

Its surface is very limited, it is under strict military govern- 
ment and police, afibrding all the means, lohen so loished hy the 
authorities, for the most scrutinising investigation ; and the 
population (civil and military, about 22,000,) not sufficient to 
embarrass the ready attainment of facts, yet large enough, to 
give all the materials necessary for drawing solid conclusions. 

Under these circumstances ample opportunities are afforded 
for the detection of erroneous statements. 

I have before referred to what I consider as the first recorded 
epidemic at Gibraltar in 1649, which I believe to have been 
Yellow Fever, from the mortality it occasioned, and from its 
originating in the month of August. Since its occupation by 
the British in 1704, the following visitations of Yellow Fever 
have occurred in Gibraltar. 

1804. 

The severest on record (commencing in August), when, in a 
population of about 1 5,000, the following number of deaths took 
place :— 

Military .... 869 
Civilians .... 4864 

5733 

1810. 

(Scattered or sporadic cases.) 
Military .... 6 
Civilians . . . .17 



23 



its Occupation by the British. 



159 



1813. 

Military 391 

Civilians 508 



899 

(Between the 8tli of September and tlie 3rd of December.) 

1814. 

Military . . . . 114 
Civilians . . . • 132 

246 

From August to November. 
1828. 

Military .... 507 
Civilians . . . .1170 

1677 

From August, to tlie 14tli of January 1829, wlien tbe last 
deatli took place from Yellow Fever. 

In nearly all the foregoing, it will be observed that the 
disease commenced in or about the month of August, as is found 
to be the case in the great majority of Yellow Fever epidemics 
throughout Spain.* 

It would be impossible to enter fully into the numberless 
details connected with the origin and progress of the Yellow 
Fever at Gibraltar in 1804, 1810, 1813, and 1814. 

But in the works of Sir William Burnett, Director General 
Navy Medical Department, — the late Dr. Bancroft,t Deputy 
Inspector General of Hospitals, — Mr. Amiel,+ formerly on the 
Sta-fi:^ and attached for some years to the civil poor of some of 
the districts of Gibraltar, afterwards surgeon of the r2th 
Regiment in the garrison, and, lastly, many years surgeon to 
the Civil Hospital, who was in fact the chronicler of all the 
diseases of the Rock for nearly 40 years, — and Dr. 0'Halloran,§ 
formerly of the 64th Regiment, — most ample accounts are 
furnished, (especially by Dr. Bancroft, in his Sequel to his 
Essay on Yellow Fever,) showing the very wrongful efforts of 



* " The epidemic which reigned in Andahisia in 1804, commenced in the month 
of August in ten, and in September in eight of the twenty-three towns in which 
it prevailed that year." — From Barcelona Manifesto of \5 Physicians (Maclean's 
Evils of Quarantine Laws, p. 131.) 

f Essay on Yellow Fever," and " Sequel to Essay on Yellow Fever." 

X Memoir on Yellow Fever. — Edinburgh Med. and Sur. Journal, April, 1831. 

y On the Yellow Fever of the South and East Coasts of Spain. 



160 



Cases in the Dockyard in 1813. 



persons with exaggerated views of tlie utility of quarantine, 
to prove the disease of a highly contagious nature. 

It will therefore be indispensable that those who desire to 
obtain a correct view of the occurrences which took place in 
those years regarding Yellow Fever, should make themselves 
familiar with the writings of the above mentioned authors, 
many of whose statements I had an opportunity of verifying 
after my arrival in 1822. I have been assured by Mr. Amiel^ 
that the impression given* by the present superintendent of 
Quarantine in this country, as to the disease having been cut 
short in 1810 by his recommendation of segregating the cases, 
is utterly fallacious ; for, as has also been specially certified to 
me by the Signor Bobadilla, a respectable practitioner resident 
during many years in Gibraltar, the progress of the disease was 
stopped *^ as it is always found to be," by the setting in of a cold 
wind from the north. f 

It must be obvious that placing a point like this on its true 
footing is of the highest importance. Notwithstanding the 
body of evidence on record against contagion in all the Gibraltar 
Yellow Fever epidemics up to the year 1814, and though from 
Bancroft's works it appears that among the medical men of that 
garrison the majority of opinions had been greatly against it, it 
was nevertheless natural that unbiassed persons should become 
influenced by the statements published by two officers of the 
Quarantine Department,:]: who, having been on the spot, had 
ample opportunities of arriving at the truth. The circumstance 
here alluded to is the assertion that, during the epidemic of 
1813, the people employed in the dock-yard having been strictly 
separated from the rest of the garrison, remained free from the 
disease. Here, then, was, if true, evidence in support of the 
utility of quarantine, and of the propriety of separating the 
healthy from the sick, But what Avas the astonishment of 
the profession on finding that mis-statements had here 
TAKEN THE PLACE OF FACTS, as shown by Dr. O'Halloran. 
During my residence at Gibraltar, I had ample means, by re- 
ferring to the official authorities at the dock-yard, of confirming 
the assertion of Dr. O'Halloran that several cases of the fever 
prevalent in 1 813 occurred there, as well as some deaths ; indeed 
the names of twenty- three (of which seven proved fatal) are 
given in another place, || so that no impressions favourable to 
the accuracy or candour of the Quarantine officers can be enter- 
tained ; and in the justly severe remarks of Dr. O'Halloran 



* See Pym on the " Bulam" Fever, 
■f See Addenda (B.), p. 209, 

X Sir William Pym,— and Inspector W. W. Eraser : the latter in a published 
letter to Lord Chatham, the then Governor. Mr. Fraser was afterwards appointed 
Quarantine Officer in Liverpool. 

II See Addenda (C), p. 210. 



Board of Inquiry on Epidemic of 1828. 



161 



to which no reply has been made, future observers of cir- 
cumstances connected with the public interest, as well as the 
medical officers of the navy and army to whom the Superin- 
tendent of Quarantine has dedicated his work, have received a 
salutary warning against a too hasty credulity. 

Gibraltar Epidemic of 1828. 

I shall now refer to the facts bearing on contagion, as they 
occurred during the epidemic in 1828, when it fell to my lot to 
observe its rise, progress, and termination. At the commence- 
ment of the epidemic there were very few medical men in the 
garrison who could be called anti-contagionists. Conceiving 
that our medical chief, the late Dr. Hennen, was disposed to 
make up his mind, perhaps too soon, against importation and 
contagion. Dr. Thomas Smith, late surgeon of the 23rd Regi- 
ment, and myself, wrote to request that he would give further 
attention to the reports regarding the importation of the disease 
by a Swedish ship from the Havannah, called the Dygden ;* but 
an impartial consideration of all the facts which passed in evi- 
dence before us subsequently, left no doubts as to the cause, 
being of a strictly local nature. At the strangely constituted 
Board appointed to inquire into the origin of the disease, much 
passed, over which a veil has too long been suffered to hang. 

On the cessation of the epidemic, a despatch was forwarded 
to the Governor of Gibraltar from the late Sir George Murray, 
then Secretary of State for the Colonies, directing a commission 
of inquiry for the purpose of establishing the origin of the 
disease, and to decide on the question of its alleged importation, 
at which he himself, the Governor, was to preside, t 

Not finding himself equal to the task, however, the Governor, 
with the sanction of the Secretary of State, appointed (to the 
astonishment of all who had read the works of Dr. Bancroft 
and Sir William Burnett) Dr. Pym, British Superintendent of 
Quarantine, to take his place. Thus in fact, creating that 
gentleman a judge presiding in his own cause, and converting, 
as my readers will perceive, an investigation on a most im 
portant subject, into a mere mockery. 

The Board was composed of the following gentlemen : — 

President. 
Dr., now Sir William Pym. 

Members. 

T. Jones Howell, Esq., Judge Advocate, and Judge of 
the Vice-Admiralty Court. 

* See Addenda (D.), p. 212. 

t *' As the object of the proposed investigation is merely to ascertain a fact, and 
may therefore be more properly accomplished by the careful examination of irapar- 



162 



Opinions of the Board of Inquiry 



Colonel Chapman, Royal Engineers, Colonial or Civil 
Secretary, &c. 

Lient.-Colonel Falla, Town Major, as sucli, liead of the 
Police, and therefore responsible for the sanitary con- 
dition of the town, state of the population, admission 
of strangers, &c. 

William Sweetland, Esq., for many years Captain of 
the Port, and, as Pratique Master, head of the Qua- 
rantine Department. 

Dr. Broadfoot, principal medical officer, and for several 
years of the Quarantine Department at Corfu and 
Gibraltar. 

Dr. Barry, Staff Surgeon, Secretary to three Commissions 
connected with Yellow Fever ; named for this occasion 
Vice Inspector of Health. 

The following is a summary of the opinions given by the 
President and members of the Board : — 

The President. — " From the very strong evidence before 
the Board of the first person attacked by the late epidemic fever, 
having been connected with the shipping, I am of opinion that 
the disease was of foreign origin ; and that neither local nor 
atmospheric causes have had any share in its production ; 
Gibraltar being one of the most healthy spots in Europe, no 
soldiers of the garrison having died of fever during the months 
of August, September, and October of 1827, and only 19 
soldiers having died from fever in the course of the five years 
preceding the year 1828, during the sickly months of August, 
September, and October."* 

Judge Howell. — " Upon a careful review of all the proceed- 
ings before this Board, I am of opinion that the evidence brought 
forward has totally failed to prove that the late epidemic disease 
was introduced from any foreign source, either by the Swedish 
ship Dygden, or by any other means ; and I am further of 
opinion that the late epidemic had its origin in Gibraltar," 

Colonel Chapman. — " Judging from the evidence produced 
before the Board, the manner in which it has been given, 
together with the description of persons who have been brought 
forward as witnesses, I am decidedly of opinion that the late 
epidemic disease was of local origin. As to the importation of 

tial evidence, than by the application of scientific research, I recommend that the 
inquiry be entrusted to a Board to be presided by yourself." — Extract of a Letter 
from Sir George Murray to Sir George Don, 'S\st October, 1828. 

* What rational inductions we have here ! ! The following is another specimen 
of contagionist reasoning : — " During the time that the disease had been going on 
onboai-d the transports in the bay, the garrison continued in perfect health until the 
20th of October [1810], when, in consequence (as I must suppose) of a breach of Qua- 
rantine regulations, which, however, could not be detected, a Minorcan family in the 
South District, belonging to the dockyard, was attacked with the disease."— P. 49, 
1st Edit. ; 29, 2nd Edit.-- Observations upon Bulam Fever, by Sir William Pym. 



on the Origin of the Disease. 



163 



tKe late epidemic, I am of opinion that the attempts to prove 
the introduction of the disease, after months of previous in- 
quiry, bj those who wished to prove it, have wholly failed." 

Mr. SwEETLAND. — "After the most attentive consideration 
of the evidence which has been brought forward, I have dis- 
covered nothing which has carried conviction to my mind as to 
the cause or origin of the late epidemic fever. On the one 
hand, it has not been shown, that any of the causes stated in 
support of the doctrine of its being of domestic origin, existed 
in a higher degree in the year 18*28, than in many preceding 
years, when the garrison was free from that disease ; and on the 
other hand, no vessels have arrived during the last summer 
having the Yellow Fever on board, nor has that disease dis- 
covered itself among any of the shipping in the port. In the 
absence, therefore, of any proof on either side, I must decline 
hazarding an opinion on a subject which has hitherto baffled 
the researches of the most learned physicians of all countries." 

Lieut.-Colonel Falla. — I am of opinion that the late epi- 
demic was not of local origin ; but, from the strong presumptive 
evidence before the Board, that it was introduced." 

Dr. Broadfoot, — Opinion, at great length, may be consi- 
dered literally both for importation ; — and local origin. 

Dr. Barry. — " I am of opinion that the late epidemic was 
not of local origin, and was imported." 

With regard to the statements of some of the members of 
the Board, concerning the condition of the town, I was much 
struck, on my first arrival, with the general cleanliness of the 
streets; but my observations, after a settled residence, con- 
vinced me that, in numberless localities, its sanitary condition 
was exceedingly imperfect, notwithstanding what appeared to 
be the great care taken by the authorities to prevent accu- 
mulations unfavourable to health. 

During the summer season, the sewers necessarily retain a 
quantity of filth, till carried off by the heavy periodical rains, 
on the recurrence of which their cleansing entirely depends at 
all seasons of the year. No summer passes without offensive 
smells emanating from those sewers, both within the walls of 
the town, and about the barracks and houses in the district 
called " South,"* especially during the eddying gusts of an 
easterly, — or a direct westerly wind. 

Cesspools are numerous, the town being but partially sup- 
plied Avith water-closets, and these having often an insufficient 
quantity of water, whilst many of the drains are constructed 
without a proper fall. It has been established, by the inves- 
tigations which took place in the autumn of 1828, that, in the 
districts within the walls in which the fever first prevailed 



* See Plan, figure 8. 



164 



Sanitary Condition of Gibraltar. 



(Nos. 24 and 25*), there was a greater accumulation of filth 
than ordinary in some of the branches of the sewers, and in 
the soil-pits. I am of opinion that when certain conditional 
causes, or more properly conditional states, exist, which favour, 
by their fortuitous assemblage, the emanation from the earth 
of the peculiar poison productive of Yellow Fever, a more 
accelerated developement of that poison is likely to take place 
near such places ; and, in this view, foul sewers may fairly be 
considered as accessories. f To deny the influence of localities 
(as the neighbourhood of drains, gullies, &c.) as co-operating, 
in the development of the disease, or even in giving it a 
higher deorree of malignancy, would be excluding facts which, 
in the minds of impartial people, must be quite conclusive. 

Objections may, beyond all doubt, be made against the manner 
in which a great part of the town is constructed ; many places 
inhabited by the poorer classes being excavated or scarped, to 
make room for the buildings, which, range after range, ascend 
for a considerable way up. Many of the houses have, therefore, 
from their being thus built on the side of the rock, necessarily 
most inadequate ventilation. 

A common feature of the dwellings is that of small ""patios^ 
or square confined courts, entered by narrow alleys, in which 
the houses consist of several floors^ each occupied by many 
families. 

Gibraltar is therefore to be considered as greatly overcrowded, 
which may perhaps be conceived from a reference to the view 
attached to this report, showing the small space occupied by 
the town, near the northern extremity of the rock. 

It was not until I had become principal medical oflicer,J 
in 1833, when I considered it my duty, as general superin- 
tendent of the health of the population, to visit, all the lanes, 
alleys, and '* patiosT that I could have formed any idea of the 
densely crowded and badly ventilated houses of these localities, 
and of the difficulty of conceiving how such places should in 
general prove healthy, amongst a mixed population of about 
15,000, exclusive of military, within the walls. 

For here we have, in the inadequate supply of water, — the 
existence of cesspools and ill-constructed drains, — and the over- 
crowding, — precisely the same assemblage of predisposing or 
localizing causes which are found to exist in the fever nests of 
London and other large towns, and which are so prejudicial 
during the prevalence of epidemic diseases. 

In reference to the first appearance of Yellow Fever in 

* Plan (A.) 

t See Dr. Hennen's Letter to Sir G. Don, Addenda (E.), p. 212. 

X Soon after my appointment it was ordered by the Colonial Office, without any 
communication from me, that the principal medical officer should also act in the 
capacity of Medical Member of the Quarantine Board. 



Gaural Jlamtl or MmWp.__On Mj>w Jivcr. 




OPPOSITE THE SIGNAL POST 



Reference to Mr. Howell by Sir George Murray. 165 

1828, it is perfectly established, that the late Dr. Hennen, 
so early in the season as the end of July, visited a woman 
living in the district in which the disease first became preva- 
lent,* who, according to that gentleman's statement to Mr. 
Woods, then assistant surgeon, 94th regiment, laboured under 
the purest form of true Yellow Fever: this woman died. 

It may be readily conceived, that in a disease where the 
symptoms are sometimes very slight, it was not easy to ascer- 
tain who were actually the first attacked, but 29 cases were 
generally admitted as having occurred up to the 1st September, 
in the southern and hottest parts of the town, j 

On the appearance of the first cases of the fever, vague 
reports were freely circulated, that the disease was imported 
by the Swedish ship Dygden." 

The first proof, against its having been so imported, was 
contained in a document which I had seen from Mr. Sweetland, 
the Captain of the Port, from which it was clear that no person 
on board this ship could have communicated the fever to any 
one on shore, on the simple principle, that we cannot transmit 
to others that which we have not ourselves.J 

Immediately on the decline of the epidemic, I prepared a 
lengthened statement concerning Yellow Fever, in which I 
entered into every detail connected with the first appearance of 
the disease at that time in Gibraltar, as well as its progress. 

This manuscript I have laid before difierent persons in high 
authority, and it was my intention to embody in this report 
much, if not all of the evidence I had collected^ with a view* 
to show the unfounded nature of the statements as to the 
importation and contagion of the disease in the garrison. But 
circumstances have enabled me to refer the reader to a clear 
exposition of all the proceedings on that occasion, conveyed in 
a manner which will render them more conclusive, and in 
every way more satisfactory. 

I have furnished the several opinions of the members of the 
Board before alluded to ; after due consideration of which by 
Sir George Murray, that acute observer saw fit to require from 
Mr. Howell, the only member of the legal profession on the 
Board, his reasons for not being in favour of importation or 
contagion. That gentleman gave a most elaborate reply, a copy 
of which will be found (p. 245) Appendix No. 11. 

Conclusions similar to those expressed in that document, 
had been placed on record by me in my details of the progress 
of the epidemic ; — and it always appeared most extraordinary, 
and unjustifiable, that on this Board of inquiry which was 
intended by the Secretary of State to be so beneficial to the 



* District 24. Plan, Letter A. f 24 and 25 Districts on Plan. 

. X See Addenda (R), p. 214. 



166 



Cases in the 4ord Regiment. 



interests of humanity, tlie Superintendent of Quarantine as 
president, should have assumed the right in several instances of 
selecting the witnesses, which obviously prejudiced the question, 
and by which much of the truth was intercepted. 

Several medical officers of the garrison who had much expe- 
rience respecting the progress of the epidemic, were either not 
examined at all, or only in a very imperfect manner. I was 
among the latter, being surgeon to the 43rd Regiment, and 
present during the whole epidemic. After a very limited 
examination, I officially informed the President, by letter, that 
I had much to state ; but like others, I was not called afterwards. 

From what I felt due to the service of which I had been a 
member for so many years, as well as the cause of truth, I was 
induced to protest against such proceedings, which protest will, 
I presume, be found with the documents connected with the 
inquiry forwarded from Gibraltar to the Colonial Office 

In addition to Mr. Howell's observations upon the evidence 
of the witness Catalina Fenic, I think it well to state, that this 
woman having been cited on the 14th November, 1829, before 
a public JNotary at Gibraltar, deposed as to the falsehood of the 
report that her children had visited the ship Dygden."* 

I may mention that on my arrival in the West Indies in 
1801, the progress of Yellow Fever, to a frightful extent, in 
Martinique and Dominique, among the newly arrived regiments 
only,-\ did not fail to convince me that all those under whom I 
was acting, were right in not considering it a contagious disease ; 
the idea was never harboured, nor ever discussed, so plain and 
obvious were the facts. :(: 

With regard to the Gibraltar epidemic of 1828, I am able to 
state, that in the 43rd regiment, the admissions of Yellow Fever 
cases commenced on the 12th September, and though, between 
that day and the 29th September, 43 cases were treated, no 
hospital attendant was taken ill. The first day an hospital 
servant was attacked was on the oOth September, his employ- 
ment that of cook, and his duties unconnected with the wards 
or the sick; he slept in a kitchen. The waterman fell ill 
whilst following his employment, that of bringing water from 
a distance, and his duties never took him into the wards. It 
was not till this period, that the southern district, in which 
there are about 173 houses, § and where the hospital, containing 
the sick of six regiments, was situated, || became affected by 
the noxious emanations which prevailed. What took place 



* S^e Addenda (H.), p. 223. f See Appendix No. IV, p. 381. 

X " To my great astonishment," says M. Dariste, who had been in the West 
Indies a great many years, " I found, on my return to my country, that the question 
as to the contagious property of the Yellow Fever was warmly agitated." 

§ Plan, Figs. 8, 8, 8. |) Plan, Letter (D.) 



Comparative Exemption of Hospital Orderlies. 167 



respecting tlie Orderlies of tlie 43rd, was also observed in tlie 
other regiments ; and with all the medical officers, who had 
had no previous means of judging, this was a striking circum- 
stance calculated to inspire confidence. Those of our permanent 
orderlies who suffered, were, for a month, in close contact, by 
day and night, with the patients, before being attacked. I was 
informed by Mr. Martin, surgeon 73rd, that, after his hospital 
was moved to the barrack at Windmill Hill,'"^ he had no hospital 
servant taken ill. 

The same took place in the 94th, under medical charge of 
assistant-surgeon Bulteel, the hospital of which regiment had 
also been removed to Windmill Hill. 

But a circumstance which occurred in the 43rd is calculated 
to set at rest the question of transmission by contact, as well as 
by inhaling the atmosphere of a ward in which Yellow Fever 
patients are placed : — no experiment could possibly be devised 
more calculated, to put these matters to the test. 

Not having civil servants, from the breaking out of the 
epidemic till the 13th of October, (a period of exactly one 
month.) we had from one to three men sent us, daily, from the 
barracks or camp,t at the northern extremity of the rock. They 
were relieved every 24 hours, with one or two exceptions. 
The numbers which had been sent, during the month, amounted 
to 69. Here then we have an experiment on a scale that 
cannot be rejected by the most fastidious. 

I give (Addenda T., p. 240) the names of those men ; J and 
in order to prevent doubt respecting so important a document, 
I procured the signature of the Adjutant of the Regiment, 
which will be found affixed to it. The date of each man's tour 
of duty at the hospital is added. 

By an examination of that return, it appears, — 

1st. That two-thirds of those men were not attacked. 

2nd. That while individuals in camp who had never ap- 
proached the sick, but had more or less communication with 
the town, (mounting guard, &c.) were taken ill, in the pro- 
portion of 1 in 3j, it happened that those Orderlies afterwards 
suffered in a considerably less proportion. 

3rdly. That one-third of those attacked had, subsequent 
to their being on hospital employ, mounted guard, or taken 
other duties, in localities where other men had been frequently 
taken ill. 

4th. That, keeping in view the proofs of the latent period in 
Yellow Fever, being confined to a few days, this return affords 



* Plati, Letter (F.) 

t Plan. Letters (M.) and (P.) 

X I handed in this list, with the various particulars, to the Commisrion appointed 
to examine into the Origin, &c., of the Yellow Fever ; and I presume it was for- 
warded to the Colonial Office., with their proceedings. 



168 



Non-communication hy Fomites. 



tlie clearest evidence tiiat tlie attacks, in none of tlie cases^ can 
be attributed to the men having been employed on hospital 
duty. It will be seen that some were attacked many days 
beyond the estimated latent period, and some not for several 
weeks ; all being, in the interval, exposed to the influence of 
local causes. 

It is needless to refer to what the duties were of the above 
69 men, constantly in the wards ; — supporting the sick while 
at the night chair ; — washing them ; — assisting to clean their 
mouths when affected by haemorrhage; — making their beds; 
— shifting their linen ; — acting as night guards ; — and in short, 
occupied in every office about the sick.* 

Independently of these, others had been employed in taking- 
foul bedding to the barrack stores, without anything taking 
place calculated to lead to the belief of transmission by 
" fomites^ Concerning those persons employed as washerwomen 
by the civilians, I am able to assert, after every inquiry, that 
the results were similar to those which occurred amongst the 
individuals whose names are given in the return of washer- 
women for the regimental hospitals (Addenda U., p. 243) ; and 
that the attacks of those women could in no case be reasonably 
traced as an effect of washing the linen of people labouring 
under Yellow Fever. 

Among the medical officers attached to the regimental hos- 
pitals in the southern district similar facts to those regarding 
the orderlies, &c , were observed ; none having been taken ill, 
till an advanced period of the epidemic, when families in 
private houses in the neighbourhood had been long affected. 
This was most remarkable in an establishment formed towards 
the close of the epidemic on ground near the orrillon ditch,t 
North Front ; where none, — among susceptible J orderlies, and 
medical officers, peculiarly susceptible from their having not 
long previously arrived from England, — were attacked with 
the fever. 

I shall next refer to the non-transmission of the Yellow 



* Our experience in respect to hospital attendants was confirmative of what is 
recorded on many occasions ; especially at Barcelona, in 1821, (as stated in the 
Keport on the Documents of Dr. Chervin, read at the Academy of Medicine of 
Paris,) where, in one instance of 150 persons appointed to attend on certain 
houses occupied by sick, the proportion taken ill did not exceed that of the general 
mass of inhabitants attacked. Of 32 persons employed at the hospital called 
Nazareth, near Barcelona, in the same year, not one was attacked during the 37 
days that hospital was established, — but several suffered some time after their 
return to the city, when the establishment was broken up. Another similar 
instance occurred in the Queen's Hospital, near Barcelona, in the same year. See 
also Appendix No. III., p. 284. 

t Plan, Letter (G.) 

1 This word is used by me throughout, in its common application, in reference to 
Yellow Fever that is, that the individuals in question have not had a former attack. 



Encampment on Neutral Ground. 



169 



Fever to patients under treatment in hospital for other 
diseases. 

Previous to the " Naval Hospital " having been appropriated, 
exclusively, to cases of the epidemic fever, all diseases belong- 
ing to six regiments were for some weeks treated in that 
buildini^ ; and during the residence of non-febrile cases in 
hospital (with merely the general arrangement of placing them 
in different wards) the same results took place ; — none were 
seized with the fever till it had previously spread among the 
inhabitants of the district in which the hospital is situated. 
This, I believe, is in accord with what happened at Gibraltar 
in former epidemics, and with what is so often recorded as 
occurring in the West Indies and other places. 

At the com.mencement of the epidemic the population of the 
districts first infected, consisting of about 4,000 persons, aban- 
doned the town by order of the authorities, and encamped on 
the Neutral Ground. They took with them their bedding, 
furniture, &c., and this was the case with families which had 
had some of their members previously attacked. 

Had the disease been of a contagious character, what must 
have been the result ? — naturally, that the fever would spread 
in the camp, huts, &c , but this was not the case. * 

There was no spreading of the disease from the convalescents 
belonging to the army who went out to camp. But one cir- 
cumstance is particularly worthy of notice. I was informed by 
Mr. Hugh Fraser of the Civil Hospital that, of great numbers 
of poor who had been treated in this establishment, one third 
at least rejoined their families in camp, taking with them 
their clothes, &c. , and yet no spreading of the disease ! Many 
of these were discharged for want of accommodation previous 
to their being advanced in convalescence, and some while still 
bleeding from the mouth. f Can proof stronger than this be 
required ? 



* The Superintendent of Quai'antine in the second edition of his book (1848), 
p. 34, says, — " Upon the Neutral Ground there is a constant and strong breeze or 
current of air sufficient to destroy the contagion of any disease, and iu this way 
the contagion not spreading is to be accounted for." We have here an instance 
of the never-failing efforts of this gentleman to lose no opportunity of turning 
everything to his own views of contagion ; for instead of there being this constant 
and strong breeze on the Neutral Ground in the summer months, the air is often 
stagnant, and the heat intolerable. In my frequent visits to the camp during the 
epidemic, I often experienced an insupportable oppression in the tents ; and my 
opinion is that the poison productive of Yellow Fever, instead of being generated 
in the bodies of the soldiers, and then dissipated by strong breezes, is not produced 
at all on the naked surface of this locality. 

f In the Yellow Fever epidemic at Leghorn in 1804; circumstances analogous 
to these occurred. It is recorded that 6,000 persons left that city for Pisa afterthe 
outbreak of the disease, and that the French army, ivitli 180 men labouring vnder it, 
also removed lo the same place ; yet under these circumstances the disease was 
not propagated at Pisa. See Palloni on the Yellow Fever in I egliorn iu 1804. — 
Addenda (I.), p. 224. 



170 



Exemption of Susceptible Persons. 



In corroboration of tKe non contagious nature of the Yellow 
Fever, founded upon tlie facts already related, the course of 
the disease in civil life at Gibraltar furnished the most ample 
details. It would be an endless task to point out instances 
in which, contrary to all the laws of contagion hitherto ob- 
served, two, three, or more susceptible members of a family 
escaped, while exercising every kind office towards an equal 
number labouring under the disease. It is not my intention to 
attach any weight to the escape of an individual in a family ; — 
this we know is an every -day occurrence in diseases reputed 
contagious ; but in diseases of this last description, men of the 
highest intellect and experience have been employed in ob- 
taining an average of the numbers who may escape ; some have 
rated this as I in 26, while others estimate it as 1 in 34. 

Now the instances of exemption in susceptible persons at 
Gibraltar, bore no relation whatever to these proportions, — for 
did space permit, I could quote a great number of instances, in 
which the majority lay quite on the side of those who escaped, 
though " susceptible." The weight of such facts must, among 
those devoted to the examination of such subjects, be of great 
effect, in leading to the formation of just opinions ; but such 
persons must perceive that where a single individual only has 
been affected, while surrounded by many susceptible persons, 
the proof of its not being transmissible, becomes so multiplied, 
as to approach demonstration.* 

As a conclusion to be drawn from the observations of unpre- 
judiced people, it must be stated that the number attacked bore 
no proportion to those exposed to contact with persons labouring 
under the disease. f Coincidences, giving an appearance of con- 
tagion, may, and frequently do, present themselves, during an 
epidemic ; but it is presumed, such circumstances, will in the 
present day, have little chance of influencing public opinion, 
however ingeniously represented. The occurrence of attacks 
in an inverse ratio to exposure (had contagion existed) was 
one of the most striking facts which occurred. By the kindness 
of several army medical friends, I was furnished with memoranda 
from the different regiments, from whence it appeared that in 
families, among the military, the father, mother, or child, had 
been taken ill in 144 instances; and that the total number 

* Among numerous instances, the case of a woman named Ackerman, of the 
73d Regiment, was remarkable, inasmuch as she remained throughout her illness 
in a shed where there were no fewer than 18 or 20 susceptible individuals, without 
the disease being transmitted to any of them. 

■\ A strong circumstance illustrative of this occurred in the family of Mr. Duguid, 
some of the members of which having contracted the disease, while residing in the 
town, were removed whilst ill to the Neutral Ground, and lodged in a confined 
shed. In that shed several others of the family had, as I have been informed, 
communication with the sick; but they were not affected with the disease. Here 
the safety to the unaffected was manifestly owing to their having left an iT)fected 
locality. 



Women and Children of 12th Regiment. 



171 



composing tliose families amounted to 516, of wliich 372 were 
not attacked. In these cases the exposure, did contagion 
exist, was infinitely greater than among unmarried soldiers, 
who slept separately. 

It may be observed that in families the endeavours to conceal 
disease, are very great, on account of the unwillingness of the 
parties to be separated. Having examined the returns of those 
attacked, out of the above 516, I can state that it was impossible 
to trace the illness of any one member of a family to contagion. 
Whenever more than one were attacked, they had been 
equally exposed to local causes ; where they had not been so 
exposed, they remained unaffected, though in the closest contact 
with the sick relative in the house or tent. This was very 
clearly established in many instances. 

" Ninety-two women," says Mr. Amiel, of the 12th Regi- 
ment and 190 children, who were never allowed to re-pass 
Bayside barrier, have continued perfectly healthy ; and one 
woman only (the armourer's wife), who during the period 
obtained leave to enter and stay a few days in the garrison, 
caught the fever and died of it." 

Several of these women passed the night in the same beda 
with their husbands, attacked with, and labouring under, the 
epidemic fever, and besides continued, as well as their nume- 
rous children, to use the same bedding after the men had been 
removed to the hospital ; but in no instance was the disease 
contracted by the wife or the children, even after that full 
exposure." 

No regiment had so few women or children exposed to the 
malaria of the Rock as the 12th ; and the exemption was pre- 
cisely in proportion. We seem to approach demonstration at 
every point upon which this question can be taken up. 

Other circumstances must not be omitted, in order to show 
that there was no analogy between this epidemic and diseases 
reputed contagious. In epidemics of small-pox, measles, scar- 
latina, &c., other diseases exist simultaneously, but in 1828, 
as in similar epidemics at Gibraltar and elsewhere, all other 
diseases seemed to pass into its form, or to be altogether pre- 
vented from appearing.* 

In diseases reputed contagious, changes of temperature have 
not so manifest an influence in their disappearance ; and it 
seems incompatible with contagion, that Yellow Fever epidemics 
should, as they are known to do, appear and disappear at 
particular seasons of the year. 

In regard to the efficacy of fumigations in preventing the 
propagation of diseases reputed contagious, the analogy with 



* I am to be understood as speaking of what seems to be a general law : excep- 
tions certainly occurred. 

N 2 



172 



Local Causes. — Virulence 



Yellow Fever ceases. Having been very intimate with Dr. 
Arejula, I received from him a short memoir on the inefficacy 
of fumigations. He intended that this memoir should have 
been published with his work on Yellow Fever in 1806; but 
it was suppressed, by order of his then absolute Government. 

Let us enquire from whom our soldiers could have been 
receiving the contagion during the four months the disease con- 
tinued. Were our men mixing with the civil population, and 
entering houses which might have contained sick persons ? — 
No ; — the soldiers were for more than three months of the period 
encamped outside the walls, without having been allowed to 
enter the town except on duty. It may be said, that the mass 
of those attacked merely marched to their guard-houses, to 
which, certainly, the inhabitants were not in the habit of 
resorting, and where the soldiers, as certainly, came in contact 
with no persons suifering from Yellow Fever. Arrived at his 
post, a soldier was placed as sentry, not in the midst of a dense 
population ; not with people about him, from whom disease 
might be transmitted ; nothing of this occurred, llie guard 
in charge of the ruins of Pompeii is not in the midst of a deeper 
solitude, than were often the soldiers at Gibraltar, as they 
inhaled the " death-blast," in districts abandoned hy the inhahi' 
tants. Contagion! — Our men were far removed from contact 
with sick people ; — far out of hearing; — far out of sight. If, in 
the face of all this, the doctrine of the contagious property of 
Yellow Fever find active supporters, likely to influence Govern- 
ment, I know of nothing which can set the question at rest, as 
far as British colonies are concerned, except the intervention of 
a British Parliament. 

Local Causes. — Together with what may be inferred from 
the foregoing, many circumstances occurred demonstrative of 
the local origin of the Yellow Fever at Gibraltar in I&28; and 
similar observations have been made wherever that disease 
has been known to prevail. 

Among the troops, those who suffered in the first instance, 
were the Royal Engineers, quartered in the lower part of the 
district,* in which the fever first made its appearance. It was 
remarkable, that the 43rd next suffered seriously, though 
quartered at the Casemate Barracks, at the opposite (northern) 
extremity of the town.f This admits of explanation. The 
12th Regiment, in barracks in the town range J (situated like 
the Engineers in the lower part of the district first infected), 
left the town for camp on .the Neutral Ground on the 5th of 
September ; at which time a few cases had appeared among 



* Plan, Letter (R.) - f Plan, Letter (P.) 

+ Plan, Letter (Q.) 



of the Disease in the 4.^rd Regiment. 173 



them ; and, as long as that regiment discontinued furnishing 
town guards (18 daj^s), they ceased to have fevers, except among 
those who had from their duties as orderlies, clerks, &c., re- 
mained in town. The 42nd and 43rd, both in the same range 
of barracks, had been taking by turns for three weeks each, the 
duties in the neighbourhood of the sickly district ; and as it 
then happened to be the turn of the latter the men had these 
guards together with duties on other posts abandoned by the 
l'2tli. With this exception the 42nd and 43rd were similarly 
situated. 

Under these circumstances, the 43rd Regiment passed from a 
state of perfect health* (not having a case of fever of any kind 
for a fortnight previously) to that of deplorable suffering ; and 
before the disease had made an impression on any of the other 
regiments of the line the 43rd suffered a serious loss. This 
was at a time when the sentries were solitary beings, in the 
midst of desolation. 

The effect of locality was here manifest. 

The posts which seemed to cause the greatest number of 
sick, were those called North Flat Bastion, Southport, Convent, 
and Provost.t 

Not only were the men of the 43rd among the earliest 
attacked, but the disease assumed, in their case, an extraordi- 
nary degree of malignancy. The late Dr. Hennen (principal 
medical officer) in his report to the Director-General of Hos- 
pitals in London, states that " the impress of death seems to 
be on the men of the 43rd, who have been attacked." 

Acting Deputy-Inspector Dow also made a statement of the 
extraordinary virulence with Avhich the disease appeared in the 
43rd, and it was noticed by the medical gentleman who acted 
with me as well as by others. Circumstances like these are 
commonly known to accompany diseases arising from malaria ; 
they occur frequently in Yellow Fever. | 

* There had been upwards of 30 cases of cholera, and one death, in the regiment 
after its arrival from Portugal some months previously, 
t Plan, Letter (W,) Moorish Castle. 

X Similar facts have been observed by Dr. Jackson at Philadelphia, also by Drs. 
Monges and Hodge of that city. It is stated by the two latter, that in one place, 
or at a particular time, almost all their patients recovered; while in another place, 
or at another time, the disease was so virulent that almost all their patients died. 
In the mild epidemic of 1793 at Philadelphia, M. Monges, out of 300 patients, lost 
only a child. Authors abound with accounts of these differences. In an epidemic 
at Cadiz we are told that the regiment of Saragossa lost 800 out of 1,200. By a 
statement of the authorities at Barcelona, the loss at one establishment in the epi- 
demic of 1821 was 1,265 out of 1,739. M. Berthe, at the head of a commission 
during an epidemic at Seville, states that the loss in one part of the town was only 
1 in 1 8, while in another it v.-as one-half. The same gentleman has observed of 
the epidemic at Cadiz in 1800, that in some parts of the town the mortality was 
tenfold greater than in others. In an epidemic at Xeres it has carried off one third 
of the population, consequently in all probability foar-fifths cf those attacked 
M. Moreau de .Tonnes states, that in an epidemic which he saw in Martinique almost 
all attacked died. In Sir William Pym's book we nave many instances of great 
mortality at one point, and of comparativeiy little loss at others. 



174 



Inefficacy of Seclusion, 



In tlie Gibraltar epidemic of 1814^ Mr. Donnet, Surgeon of 
the Naval Department, did not lose more than 1 out of 32 
cases ; while the disease at other points, was much less manage- 
able. In 1828, while it ran so mildly through a family at one 
point, as not to destroy a single victim, the disease carried off 
the Vv^hole of a large family at another; and out of 34 Jews 
treated in the Civil Hospital, in the early part of the epidemic 
33 died. Are not these things far from characterising epide- 
mics reputed contagious ? We know that contagious diseases, 
will differ in force, as it respects individuals according to 
certain circumstances, but constant differences, such as these, 
are not found to take place. 

The greater security which has been remarked to exist in 
upper floors in diseases from malaria was, in some instances, 
distinctly verified at Gibraltar in 1828. In a particular instance, 
the whole of a family, living on an upper floor, escaped ; while 
every one of another, on the ground floor of the same building, 
suffered. 

The existence of local causes was also demonstrated by 
persons remaining well on the Neutral Ground, while attending 
their sick relatives, but being attacked on their return to town, 
a considerable time after, when not in contact with sick. 

The late Assistant-Surgeon Fraser, 73rd Regiment, who had 
been living in the lazaretto establishment, on the glacis near 
the Neutral Ground,* remained well while there, but was 
seized, on his return within the garrison, which exposed him 
infinitely less to contagion, had such existed. One man having 
a family of several children, had a part of them attacked early 
in September, while residing in the quarter where the disease 
first appeared. He removed into camp, where the children, 
who had been sick, joined the family after recovery, and the 
whole continued well whilst they lived in camp. He returned 
home some time after, when he conceived he might do so with 
impunity, (expurgations, &c. having taken place), but the 
remainder of the family were soon attacked. It would be an 
endless undertaking to quote all similar instances which 
occurred. The medical world may find abundant details in a 
work since published by Dr. Chervin. 

The inefficacy of perfect seclusion from persons labouring 
under the disease, as well as from all who came in. contact with 
the sick, was clearly exemplified in 1828, and other epidemics 
of Gibraltar, (see the remarkable dockyard case in I813.f ) 

One remarkable instance, under my own observation, occurred 
in the house of a lady residing near Rosia Barracks. J Her 
niece was attacked with the disease, which ended in death, 
though the most rigorous segregation had been adopted for 
some time previous. In another case, a soldier of the garrison. 



* Plan, Letter (H.) 



t Adde-ida, (C.) , p. 210. J Plan, Letter (S.) 



Diseases among Animals. 



175 



who Kad been in attendance on tlie sick in hospital for three 
days, became alarmed, and left his post, without having been 
affected. After an interval of several days, however, passed in 
solitary confinement in the Provost Prison (Moorish Castle),* 
this man was attacked and died. I should be at no loss for 
many others under this head. 

The admission by all (including Sir W. Pym), that when- 
ever the Yellow Fever has been epidemic in Spain, it has 
appeared at a particular season, and declined, with equal regu- 
larity, so soon as a low temperature has set in, must always 
have great weight in establishing the local origin of the 
disease ; heat being known to favour the production of diseases 
originating from noxious emanations, f 

Whatever was observed as to the influence of local causes in 
producing the Yellow Fever in 1828, had been noticed by im- 
partial people in the progress of former epidemics at Gibraltar. 

The neighbourhood of Boyd's- buildings, J famous in 1804, 
again became one of those points from whence the origin of the 
disease emanated^ though no trace of the houses remained 



* Plan, Letter (W.) 

t Some occurrences affecting the lo"vv-er animals, observed during the epidemic, 
were proofs of the existence of a morbific atmosphere. Dr. Arejula had pre- 
viously observed, that in Cadiz, Malaga, &c., birds abandoned those places while 
the disease continued, but returned on its disappearance. He informs us that he 
announced to the inhabitants of Malaga that their epidemic was about to leave 
them, merely because he saw the sparrows returning to their usual haunts ; he 
tells us that dogs especially suffered from the same symptoms as the persons 
attacked; next were cats, then horses, fowls, and canaries, the latter died after 
throwing up blood; ; dogs and cats also suffered this last symptom, but vomiting 
and dark stools were more common in the latter. " Of three dogs (setters) and 
two cats in my house none escaped an attack, and in all i observed the black dis- 
charges from the bowels ; the dogs recovered and the cats died. The horees 
which I saw die had either the marble coldness of the extremities, or general con- 
vulsions. It may be presumed that pigeons and other birds suffered the same 
disnase, but I did not witness them, neither did I witness this in fishes ; but it was 
stated that at the time there was great mortality among them," I am not aware 
that quite so much as this was observed at Gibraltar in 1828, but it is beyond all 
doubt that there was an extraordinary mortality among animals, as dogs, cats, 
monkeys, parrots, &c. In a small and remarkably ill-ventilated yard, in which 
several servants were taken ill, three dogs died, Mr, Bonfante, a merchant at 
Gibraltar, drew out a list of eleven animals that died on his premises. Mr. Duguid, 
another merchant, also informed me that nine or ten dogs had died on bis premises, 
and the skin of the greater number became yellow. Two of these dogs I myself 
saw, while still alive, with yellow skin. It was stated by one of the servants that 
the oldest of these animals had a short time previous to her attack abandoned 
the place where she usually slept, and endeavoured to establish herself in an 
upper part of the building. Mr. Danino, also lost several animals. A monkey, 
belonging to Mr. Griffiths, died, the skin and eyes being distinctly yellow. A 
goat-keeper, residing on the southern part of the Rock, lost a considerable number 
of his flock. I was informed by some of the private practitioners that they saw 
black vomit in some of the animals which perished. It is a curious fact that in 
the same place in which Mr. Duguid"s dogs were seized in 18-28, a fine healthy- 
pointer brought from Spain died the following year, labouring under precisely the 
same symptoms, — yellow eyes and skin, bloody dejections. &c In the examination 
of this dog no inflammation of any of the viscera was discovered. 

X Below letter B, on plan. 



170 



Intervals heticeen Epidemics. 



whieli had existed in tliat year.* As in former epidemics, 
tlie disease was confined to tlie town for some time, and was 
then found to break out at several points in the southern part 
of the Rock.f Similar to this is the progress of other diseases 
not arising from contagion. 

If it be asked, why local causes produce the Yellow Fever at 
Gibraltar, &c., only at intervals of many years ? I would ask, 
in turn, why the cholera which raged at Ceylon in 1817, had 
not appeared there for 48 years previously ? I would ask why, 
in 1812, ague appeared, for the first time in certain high 
situations in Portugal ? It might be asked, why there was an 
interregnum from the appearance of the Yellow Fever at Marti- 
iiique,from 1807 to 1816, as stated by Dr. Dariste, who practised 
in the island for 30 years, and who tells us that the old inha- 
bitants speak of intervals of 25 years between the prevalence 
of their epidemics. A long interregnum is well known to occur 
at Antigua, St. Vincent's, Sta. Lucia, PhiladeljDhia (46 years) 
Charleston (41): &c., although the commerce of these places 
usually varies but little. 

I would ask, why the very remarkable disease which appeared 
a few years ago in Paris, to which the name of Acrodyjiia was 
given by the Faculty, — had not before appeared? 

A hundred such questions might be asked to which it would 
be equally difiicult to reply, as that respecting the periodical 
a23pearance of Yellow Fever. But the question is taking its 
natural course, and for 100 advocates, which 30 years ago, might 
be found on the side of contagion, 10 will not now appear (in 
countries where it is permitted to express free opinions) who 
support that side of the question. Such may be really worthy 
persons who have not had sufficient opportunities of studying 
the disease, — and those interested in maintaining its exotic origin. 

It must be confessed, by all unprejudiced persons, that the 
closest investigations have failed in the discovery of the imme- 
diate, essential, sine qua non, cause of Yellow Fever. 

Up to the latest authorities, \ we can obtain no more satis- 
factory hypothesis than the high probability of the influence of 
certain terrestrial emanations. What seems quite established 

* Dr. Prout, in his Bridge water Treatise, expresses an opinion to the effect that 
a small quantity of malaria ii ay prove a source of considerable mischief. 

-{ In a Yellow Fever epidemic at Seville in 1819, the disease was limited to the 
quarter called Sta. Cruz, and certificates from physicians, then given to Dr. Chervin, 
pi'ove that out of that quarter servants in lazaretto, hospitals, &c., were not attacked. 
At Arcos two large districts of the town remained uninfected, when the Yellow 
Fever appeared there in 1801 and 1804, though the communication with them vras 
free. 

+ Dr. Bartlett, professor of the Transylvania University, in his splendid work 
" The History of the Fevers of the United States. 1847," and Dr. John Davy, 
Inspector-General of Hospitals, in his Eeport on the Yellow Fever, lately prevalent 
among the troops at ..iai-bados. See Addenda (K.), p. 226. As also in his very 
valuable notes to the " Account of the Yellow Fever Epidemic of Guiana," by 
Dr. Blair, (Loudon 1850.) 



MetcGrological Iiifluences. 



177 



in my mind, however, is, that whatever else the special myste- 
rious agent may be, it is never produced by contagion. 

The days have passed when the malaria from marshes was 
considered as essential to the production of Yellow Fever, and 
now the general opinion seems to be, that this disease is deve- 
loped both on high and low lands — that, in fact, even on hills 
of considerable height, far from the vicinity of marshes, it 
appears occasionally as an epidemic. 

Facts collected from a series of meteorological tables drawn 
up by engineers and others at Gibraltar, in the course of many 
years, are calculated to disprove the influence of certain agents, 
which have been considered indispensable to the production of 
Yellow Fever. These agents may, however, have some effect 
on particular occasions. 

PTith respect to a temperature much above the usual standard of 
the season at which the disease occurs, I find that though heat has 
been one of the conditions under which Yellow Fever has always 
been produced ; the Gibraltar epidemics have not occurred in 
the very hottest years.-\ The summer of 1828 was, on the whole, 
one of the coolest remembered for a long time, for, though it 
averaged for the Jive warm months (from June to October) 
rather a liigher range than the preceding year, the difference is 
too trifling to be considered, when it is observed that several 
healthy years had been much hotter, and that in the three 
months in 1827, corresponding to those which preceded the 
epidemic of 1828, the average heat was greater by 2 J degrees. 

For many days the contrast between our calamitous state in 
the garrison, and the beautiful scenery presented in the bay, 
and from the opposite coast, heightened by the clear atmosphere, 
and the occasional refreshing breezes from the Atlantic, was 
very remarkable. J 

Indeed, the very flourishing state of a flower-garden, near the 
scene of desolation at our hospital, was far from conveying 
pleasurable sensations. 

State of Barometer. — On this point there is little to be said. 
By observations for 10 years, from 1816, its greatest height had 
been 30 '90 inches, its lowest descent 28 ♦C2 inches. 
• Regarding the quantity of 7'ain, to the influence of which great 
weight has been attached, I have in my possession a table of 
the indications of the pluviometer at Gibraltar from 1790, 
showing that the Yellow Fever has prevailed both in seasons 

* See, especially, MaccuUoch on Malaria. &c, 

t Similar facts have been noticed by Humboldt, in treating of the origin of Yellow 
Fever at Vera Cruz (Political Essays, vol. 4, p. 202.) We have also statements 
of the best authorities as to the epidemics in Spain not appearing oftener in 
the hottest seasons, though one or more such instances may have happened. In 
1752 the heat was so excessive at Gibraltar, that the inhabitants during the night 
fancied their houses were on fire, and birds foi-sook their nests, but no epidemic 
took place. 

X I think Miss Pardoe, in her " City of the Sultan," speaks of some such con- 
trast during the prevalence of the plague at Constantinople. 



178 



Observations on Epidemic Causes. 



remarkable for the fall of much rain, and in those in which 
comparatively little has fallen.* 

W^ith respect to particular winds, I maj observe that (contrary 
to what appears to have been the case in 1804) there had been 
no unusual prevalence of easterly winds, either preceding or 
during the progress of the epidemic. It appears that, in the 
three months ending August, 1828, there were only 39 days of 
easterly wind, and only 19 in the months of July and August ; 
whilst in the corresponding three months of 1827 (healthy 
year), there were 59 days of easterly wind ; 39 being during 
July and August. 

I think it must appear, that the examination of meteorological 
variations, furnishes no satisfactory information respecting the 
cause of Yellow Fever at Gibraltar. 

It may be as diflB.cult to explain the deviations of nature from 
her ordinary course, as it is to account for her more usual opera- 
tions. We can only say, that such things are so ordained by the 
will of God. Admitting the production of Yellow Fever, in par- 
ticular localities, from concurrences in the external agents, is but 
adding one more disease to the numerous class already withdrawn 
from the ranks of contagion by our reason and experience. Who 
now seeks for the cause of spasmodic cholera, epidemic dysentery, 
influenza, &c., otherwise than in an assemblage of circumstances, 
in each case peculiar, and possessing a power of excitement 
specific in its nature ? f 

It seems to be assumed that, during Yellow Fever epidemics, 
chemical tests have discovered no very appreciable alteration 
in the air ; this may be the case, and yet nobody can doubt that 
the air inhaled in those places may be most deleterious to health. 
But during what epidemics have chemists, competent to such a 
task, been employed on those investigations? No where, I 
may venture to say, in such a manner as to produce conviction 
on this point. Is it likely that peculiar chemical properties 
could be detected in the atmosphere of all places where remit- 
tents, intermittents, &c., reign ? I presume this could not be 
expected ; but experiments hitherto attempted for the purpose * 
of discovering the precise chemical composition of the atmo- 
sphere, during a Yellow Fever epidemic, cannot be considered 
as otherwise than vague and undecisive. 

However contagionists may dwell on the exotic origin of 
the Yellow Fever, it can be always discovered that they have 

* In the healthy seasou of 1796, 62- 87 inches of rain fell ; in 1806, also healthy, 
14*76 inches only ; in 1828, 21*50 inches; — the average being about 30 inches. 

t As our experience increases we feel the force of the opinion of Leibnitz, that the 
diseases to which the human frame is subject are as various as the colours of 
flowers. 

In Humboldt's " New Spain " we have the following passage : — 
" The phenomena of life are, no doubt, subject to immutable laws ; but we know 
so little of the whole of the conditions under which disease is introduced into the 
functions of the organs, that the pathological phenomena appear to exhibit to us, in 
their succession, the strangest irregularities." 



Concurrent Authorities. 



179 



a secret feeling as to the development of this disease being 
dependant upon some assemblage of circumstances connected 
with season, hitherto not fully understood, and that many of 
them are found ready to exclaim with Arejula,* — 

" In a word, ichile the days lengthen, and the sun approaches 
our hemisphere, we may he sure that the fever, which has so afflicted 
us of late years, ivill not attack us ; hut when that luminary hegins 
to retire from us, and during the whole period of its retiring, we 
may fear it; especially if we have had a sterile season, and if hot 
and dry loinds have prevailed for many days successively J" 

Many of the facts which I have advanced concerning the 
last Yellow Fever epidemic at Gibraltar will be found corro- 
borated in the writings of the following gentlemen who were 
present, viz. — Dr. Thomas Smith, then surgeon to the 23rd 
Regiment;! Mr. R. Amiel,;j; then surgeon to the 12th Regi- 
ment, who had seen three epidemics previously at Gibraltar, 
Mr. Hugh Fraser, for some years surgeon to the Civil Hos- 
pital, having formerly served in the r2th Regiment ;§ Mr. 
P. Wilson, II assistant-surgeon, attached for many years ito the 
Civil Hospital, having been previously in the naval service. 

In Dr. Smith's paper in particular (reviewed in the United 
Service Journal for February, 1831), the public have an 
opportunity of seeing how cruelly the statements of the Super- 
intendent of British Quarantine, to the Spanish Academy, were 
calculated to operate against the deepest interests of Gibraltar, 
by favouring the necessity, in epidemic seasons, for our neigh- 
bours cutting off free communication with that garrison, which, 
notwithstanding their usual very kindly feelings, they are too 
prone to do. See also Addenda (G.), p. 216. 

From the writings just referred to, it must be evident that 
I have not been the only person, or the first, to take the liberty 
of impugning the statements of Sir William Pym** on subjects 
connected with the Yellow Fever at Gibraltar. 

* Arejula on Yellow Fever, p. 228. 

t " Brief Sketch of the Fever which prevailed at Gibraltar in the Autumn of 
1 828 ; together with Observations on the Answers of Sir William Pym to Queries 
from the Royal Medico Chirurgical Society of Cadiz, addressed to him on the origin 
and nature of that rftsease."— (Edinburgh Medical and Surgical Journal, No. 106.) 

X Edinburgh Medical and Surgical Journal, April 1831. 

§ London Medical and Physical Journal, January, March, April, and May, 1831. 

II Nos, 352, 353, and 354 of the Lancet, afterwards translated into French at 
Paris, and notes added by Dr. Chervin in Dec. 1830. 

** In a letter, dated 23rd April, 1847, addressed by Sir William Pym to the Lords 
of the Council through the Hon. W. Bathurst, relative to a Report on the Fever at 
Boa Vista, by Dr. M 'William, is furnished a copy of an official Report from the 
Board of Physicians, &c., convened at Gibraltar, by an order of the 24th January, 
1829, for investigating the question as to the liability or non-liability to a second 
attack of Yellow Fever, to which the signatures of the several members are affixed, 
with the names of Dr. Chervin and Mr. Yb.A!Ses.— dissenting. 

In the second edition of Sir W. Pym's book, however, p. 279, where a copy of 
the same document is professed to be given to the public, we find a list of the 
members at the commencement of the Report, but the signature attached is merely 
" Louis, President," — whereby the world is led to believe that the Board were 
unanimous. 



180 



References to the Plan of Gibraltar^ Sfc. 



EEFERENCES TO THE PLAN OF GIBRALTAR, IN ILLUSTRATION 
OF THE YELLOW FEVER EPIDEMIC OF 1828. 

A. — Nos. 24 and 25 districts, in the southern and elevated part of the town, 80 or 
90 feet above the level of the sea. For the most part rocky, drains and cesspools 
consequently very near the surface. Fig. 9 considered as the point where the first 
cases of the epidemic appeared. 

B. — Civil Hospital, a well-ventilated establishment, with spacious wards, about 
90 feet above the level of the sea •, in charge, during the epidemic, of Surgeon 
Hugh Fraser, and Mr. Peter Wilson, Assistant Surgeon. 

C— New Protestant Church (now a Cathedral) a little to the south of King's 
Bastion, used as an auxiliary hospital a short time previous to the termination of 
the epidemic. 

D. — Naval Hospital, on a rocky site, about 80 feet above the level of the sea, has 
accommodation for the sick of six regiments. The wards are spacious, and admit 
of communication throughout ; there is, besides, a wide corridor with entrances to 
the wards. This hospital, however, being several hundred feet lower than the rock 
behind it, the medical officers and hospital servants did not experience total immu- 
nity from attacks of Yellow Fever, as did those serving at the barrack, used as a 
temporary hospital, on Windmill-hill. 

E. — Ordnance Hospital, on a rocky site, at a great height above " Naval Hos- 
pital." 

F. — Windmill-hill Barrack, usually occupied by one regiment ; used as an hos- 
pital by the 73rd Regiment, from the 25th September to the end of the epidemic; 
situated on a rocky site, about 400 feet above the level of the sea, and having perfect 
ventilation on its south, east, and west sides. On the north side there is but a narrow 
passage between it and a stupendous mass of rock. 

G. — "North Sheds" Hospital, three wooden buildings, consisting of ground 
floors only ; erected, towards the close of the epidemic, on a low piece of ground 
close to " Inundation." outside the '• North Front defences. Here, where venti- 
lation was perfect, as at Windmill-hill, no medical officer or hospital attendant* 
was attacked with Yellow Fever. 

H. — Large marquees pitched on the glacis, outside the North Front defences ; used 
as a lazaretto, for the reception of the civil poor, in the early part of the epidemic ; 
in charge of Assistant- Surgeon Fraser, 73rd Regiment. 

I. — Sheds established about the end of December, as an hospital of observation, 
and for the non-epidemic cases of three regiments. 

K. — Tent Hospitals for non-epidemic cases among the civilians ; this the extreme 
point of our lines towards Spain. 

L. — Civil encampment at north front, to which between 4000 and 5000 of the 
inhabitants retired during a period of three or four months. This locality had been 
found a place of refuge in epidemics of former years. Ferdinand VII., King of 
Spain, contributed a quantity of wheat to the poor on this occasion. The tents 
were supplied by the British Government, It was agreed by all parties, after 
investigation, that the expected immunity was experienced here, although great 
numbers of convalescents, friends, and relatives, from within the walls of the town, 
had freely mixed with the people in these tents. The soil is sandy, with the ex- 
ception of a few acres cultivated as gardens, &c. The length of the isthmus from 
the British to the Spanish lines is 1G50 yards; its breadth, from Gibraltar Bay to 
the Mediterranean, varying from 1200 to 1750 yards. 



* The following were on duty at this hospital : — Staff-Surgeon Barry, Surgeon McLeod, 42nd 
Regiment ; Assistant-Surgeon Galeani, 43rd Regiment ; Assistant-Surgeon Davis, attached to 43rd 
Regiment; Assistant-Surgeons Gillice and Dick, 12th Regiment; Assistant Staff-Surgeons Bell, 
Fagg, and Moore ; Hospital Servants, — Thomas Ormsby, Samuel Cordingly, William Blevin, and 
Joseph Davis, 12th Regiment; John Watt, 42nd Regiment. With the exception of Mr. Gillice, 
all the medical officers had but lately arrived from England, and neither officer nor mari had had 
Yellow Fever previously. 



ural Board of EeaMi Jhi JeUov/ leva: 



IE 




References to the Plan of Oihraltar, Sfc. 



181 



M. — Military encampment, occupied by the 12th Eegiment, (which got under 
canvass on the 5th September) ; the 42nd Regiment (which got under canrass on 
the 22nd September) ; and the 43rd Regiment (-which got under canvass on the 17th 
September). This camp was established about 12 days after the first appearance of 
Yellow Fever in the town. The general exemption from attacks by the soldiers 
limited to this camp has been denied, but that such exemption really existed is 
shown in the Report. 

N. — At this side of the isthmus, many of the respectable classes, with some of the 
Sappers and Miners, took refuge, and obtained the usual immunity. 

O. — A village of wooden houses, then occupied during the warm months by 
families in comfortable circumstances as being cooler than the town, and considered 
as a proper place of refuge. This village has been since destroyed. 

P. — Casemated Barrack, near North Barrier, within the town ; occupied on the 
breakiug out of the epidemic, by the 42nd and 43rd Regiments, which aftei'wards 
encamped with the 1 2th Regiment at North Front. 

Q. — Town Range " Barracks, occupied by the 12th Regiment, previous to their 
encampment. 

R. — " Hargrave's Parade " Barracks, immediately within the southern part of 
the town ; occupied at the commencement of the epidemic by the Royal Sappers and 
Miners. 

S. — "Rosia" Barracks, in the southern district, close to the little bay called 
Rosia; situation not elevated. Occupied by the 23rd Regiment until the 14th Sep- 
tember, when they encamped on " Europa Flats," which have a rocky surface, and 
were previously considered as a place of refuge. These Flats are about 100 feet 
above the level of the sea ; and when encamped on them, the 23rd experienced 
immunity from the disease. 

T. — '* South" Barrack, built on a commanding and rocky situation, about 80 feet 
above the sea. Rooms lai'ge and well ventilated, occupied by the 94th Regiment, 
until the 10th of October, when they encamped on Windmill-hill. 

W. — Old Moorish Castle, at a considerable height within the northern extremity 
of the town ; where some companies of the Royal Artillery were quartered until 
the end of September, when they encamped partly above the " Sand Pits," marked 
6, and partly on Windmill-hill. 

X. — Sheds in dockyard, converted, as well as a brig in the New Mole, into con- 
valescent hospitals, towards the close of the epidemic. 

Catalan Bay, partly occupied by fishermen, and partly as a military post, to 
which there is an approach for foot passengers by a narrow way. The immunity 
experienced at the open camp-ground was not enjoyed at this village, which is on a 
sandy beach, backed by 1400 feet of rock, and therefore without free ventilation. 

Reference to Figures on Plan. 
Fig. 1. — Signal-house, 1276 feet above the level of the sea. 

Fig. 2. — Lower Europa, or Europa Point, 60 feet above the sea ; where, according 
to Sir William Pym, the late Colonel Fyers placed himself in quarantine during 
the epidemic of 1804, — whereas the garrison orders of Gibraltar show that officer 
performed his duties in garrison with his company, whilst residing on this Point at 
that period. The locality, however, proved then a place of safety, as it subse- 
quently did in 1828. 

Fig. 3. —Brace's Farm. 712 feet above the sea. 

Fig. 4. — Ince's Farm, 680 feet above the sea. 

Figs. 5, 5. — Two Camps, "Poco Roco" and " Buena Vista," situated high up the 
rock, near Bruce's Farm, and to which the Sappers and Miners were sent in the 
early part of the epidemic, in the belief that it might be found a safety spot. The 
expected immunity not having been found there, the men moved to the Neutral 
Ground. 

Fig. 6. — Camp ground, near "Sand Pits," not far from the New Mole, occupied 
at the commencement of the epidemic, by one company of the Royal Artillery, 

Fig. 7. — Parade-gi'ound, in the midst of an extensive space, laid out in public 
walks, and ornamented grounds for the recreation of the inhabitants. 

Fig. 8. 8, 8. — Dwellings in the district called " South," in which several cases of 
Yellow Fever occurred previous to the attendants on patients in the " Naval Hos- 
pital," (D) being attacked. 



182 



Yellow Fever in the West Indies. 



West Indies. 

Many unprejudiced persons object to drawing conclusions as 
to non-contagion from the experience of one place only, and I 
hope I may, therefore, be excused in stating, from some of the 
highest authorities, the results, at many places, where the disease 
is known to have appeared. 

Those who have entered into the subject of Yellow Fever, 
must be aware of the impossibility of giving, even a slight 
sketch of all that has been brought forward on this question. 
The discussions, up to a certain period, may be said to be con- 
densed in the works of Blane, Fellowes, and Pym, on the side 
of contagion ; and of Bancroft, Jackson, Maclean, and Burnett 
on the opposite side. The elaborate works of Dr. Bancroft 
especially, (^Is'say on Yellow Fever ; Sequel to an Essay on Yellow 
Fever,) embraced whatever could at the time be deemed the 
most essential points for consideration. 

It is usual to refer to Pere Labat's statement of the alleged 
importation of the disease into Martinique, in 1682, by the ship 

Oriflamme," from Si am ; to which it is objected that he has 
merely given vague reports of circumstances which occurred 
several years before his arrival in that island ; and that if 
the disease had been contracted at Brazil, where the ship 
touched, it was palpably erroneous to say that it had been 
imported from Siam. In the second volume, page 119, of 
Dr. Chisholm's work on the Fevers of the West Indies, he 
gives an account of an importation of the Yellow Fever into 
the island of Martinique, in 1796, which is proved to be erro- 
neous, in a paper in the eighth volume of the Medico-Chirur 
gical Transactions, by Dr. Fergusson, Inspector- General of 
Hospitals, who served with the troops on board the ship alleged 
to have imported the disease. There can be no doubt that 
among those who supported the views of Dr. Chisholm on 
contagion, respectable names are to be found ; but even so soon 
after the periods to which he refers, as 1801, when it fell to my 
lot to witness devastating epidemics in Martinique and Domi- 
nique, my experienced medical chief. Dr. Theodore Gordon, 
sen., did not think it expedient to suggest any measures appli- 
cable to contagious diseases, nor did an apprehension of conta- 
gion ever escape the lips of any of my seniors. 

Within the last 30 years much valuable information upon 
Yellow Fever has been furnished by Dr. Fergusson ; and it is 
to be regretted that want of space precludes the possibility of 
extracting, as freely as would be desirable, from documents 
by a gentleman of such great experience, tact, and candour. 
His paper, above referred to, is particularly interesting, and 
relates chiefly to transactions which occurred while he was 



Reports of Medical Officers — Fergusson, 



183 



principal medical officer in tlie West Indies, in 1816, &c. Dr. 
Fergusson's convictions are quite opposed to tlie doctrine of 
contagion ; and it will be admitted, that the facts which he 
has adduced in that paper are calculated to make a powerful 
impression.* He shows that, without restraint as to inter- 
course, situation alone (as in the present day constantly occurs 
among our troops in the West Indies) gives great compara- 
tive exeniption from the disease, — that it " is confined, in all 
the islands, to the sea-coast ;" and that, *' at Barbados, our 
hospitals, of late years, have been in a regular course of im- 
portation of the Yellow Fever from the navy ; but not even 
inoculation has been able to jjroduce the disease upon any 
member of the hospital corps, by whom I may truly say that 
the sick have been received with open arms ; for the anti- social 
doctrines of ideal contagions are not preached among us here, 
to the prejudice of duty and humanity." 

Dr. Fergusson's remarks corroborate the fact mentioned by 
other authors, as to different parts of the same town being 
differently affected : and so limited often is their influence, that 
one story of a house,t or one section of a ship, will be strongly 
affected by it, while other parts of the same tenements remain 
healthy." In the paper from which these extracts are taken, 
will be found details of the highest value, relative to this disease 
among the crew of the " Regalia " transport, employed in carry- 
ing black recruits from the coast of Guinea to the West Indies in 
1816 ; from which it appears that the crew were in good health 
previous to taking in many tons of green wood at Sierra Leone, J 

* The results of Dr. Fergusson's experience have been oflBcially lodged in the 
Army Medical Department in London, and also published since his death by his 
son. (Longman, 1846.) See Addenda, (L.), p. 229. 

t At Gibraltar, during the epidemic of 1828, this was observed to have been the 
case in a very remarkable manner ; and Dr. Ramsay, surgeon to the forces, states 
in an oflBcial report, dated Barbados, 20th December, 1825, that " in certain bar- 
racks and hospitals the very diagonal of particular apartments will afford a tole- 
rably accurate demarcation of safe and unsafe position of beds." See on this 
point also Dr. Wilson's work on Yellow Fever (1827), in which the disease is shown 
to have been confined to men whose berths were on a particular side, or in a par- 
ticular part of a ship. 

% It may be worth while drawing attention to an extract of a letter from Mr. 
Showers, ten years colonial surgeon of Sierra Leone, the first being the year 
(1816) in which the Regalia sailed from that place : — " During my ten years' stay 
at Sierra Leone I never saw any other fever (the ordinary fever of the country) ; 
but when a fever broke out there similar to the Yellow Fever of the West Indies, 
attended with black vomit, which was supposed to have been brought there from the 
Mediterranean by a ship called the Caroline, this I recognised as a different fever 
from the one I have just described as the common fever of the country ; and to 
my knowledge none of the medical men then at Siorra Leone had any difficulty in 
distinguishing it as a new and different disease." — (Alton's Dissertations on Ma- 
laria, &c., 1832.) Mr. Showers adds, respecting the fever of 1823, that he had 
*' his doubts whether it was imported or contagious ; I am much of opinion that it 
proceeded from the atmosphere which doubts he was the more justified in enter- 
taining from the fact that for two years previous no yellow fever epidemic existed 
at any port in the Mediterranean. To those who had been led to believe that the 
black-vomit fever had been not uufrequently exported from the coast of West 



1 84 Medical Officers generally, opposed to Contagion. 



— that great sickness (cliiefly dysentery) prevailed among tlie 
blacks during the voyage ; and that several deaths took place ; 
but the Yellow Fever was altogether confined to the crew ; and, 
in the words of Dr. Fergusson, " the ship, on her arrival at 
Barbados, Avas not put under restraint or quarantine, but com- 
municated freely with the sea-ports of Barbados, the Saints, 
Antigua, and Guadaloupe ; landing the severally ill or dying 
subjects of that disease amongst the inhabitants^ and at the 
hospitals at Barbados and Antigua, without communicating 
infection at any of these places ; and, finally, after having 
undergone a thorough purification, sailing from Guadaloupe for 
Europe, crowded to a very great degree with rebel French 
prisoners and their families from the gaols, under the inost 
dangerous circumstances of health, with a case of Yellow Fever 
actually dying on board the day before she left Basseterre 
Roads, but without communicating any such fever to the un- 
fortunate passengers, — leaving any behind her at Guadaloupe, — 
or importing any at the ports she ultimately reached." Dr. 
Fergusson, when speaking of an epidemic which took place in 
the following year, says, What a different interpretation the 
facts I have collected would have borne, had the present epi- 
demic that afflicts the islands broke out in the ordinary course 
of the seasons, a year earlier, at the time the ' Regalia ' was 
here." I shall only offer one more extract. " At Martinique 
they established a strict quarantine, particularly directed 
against Guadaloupe, and they have been consumed with Yellow 
Fevers ; but at Dominique, Tobago, St. Vincent-s, &c., where 
they established none at all, they have not had, in as far as 
I have learnt, a single case, although at the last-mentioned 
islands both the ' Tigris ' and ' Childers ' ships of war, imported 
distinct, well-marked instances of the disease from Point au 
Pitre, on the evacuation of Guadaloupe." 

Inspector-General Tegart, for some years Medical Chief in 
the West India islands, in his official report to the Army 
Medical Board, March 10, 1823, says, "In the various annual 
reports of the medical oflPicers in this command, I have not seen 
one favouring, or supporting the theory of contagion : they are 
all on the other side."* This seems the more remarkable, as 
isolation of Yellow Fever cases, was a measure approved of a 
short time before by Mr. Inspector Green, one of those gentle- 
Africa, its reputed birth-place, this visitation as a perfect stranger, and its alleged 
importation from Europe, must appear somewhat strange. The healthy state of the 
Eegalia transport previous to her sailing from Sierra Leone, together with -what 
appears by Mr. Showers' letter as to the non-existence of the yellow fever there 
in 1816, would seem to favour Dr. Fergusson's idea of its having been produced 
by the green wood just laid in previous to her sailing, and to " foul ballasting that 
had not been changed for years." In an official report of Mr. Hartle, it is stated, on 
the authority of Mr. Mortimer, of the Eoyal Navy, that the Nayden frigate having 
taken in green wood at Dominica lost one-third of her crew by fever. 

* Addenda, (M.), p. 230. 



Official Reports of Dr, Bone. 



185 



men who had previously served in the West Indies, ahout the 
time of Dr. Chisholm. Mr. Tegart, referring to certain cases 
which occurred at Antigua, in 1801, says, ''The result is that 
this was decidedly Yellow Fever, and that the disease ceased on 
removal from the place, and was confined solely to those persons 
who occupied the room. Here is cause and effect." 

The official reports of Dr. Bone to the Army Medical Depart- 
ment are worthy of particular consideration, he having been 
long resident in the West Indies. The substance of those 
reports are to be found in the thesis published by his son, (now 
of the Medical Department in the army,) in 1846. 

I am not aware that any one has been more competent to 
speak of West Indian fever than Dr. Bone ; he says in one of 
his reports that " the first important result which I have 
proved in the 'Naval Hospital'* is that the Yellow Fever, as 
it is called, cannot by any possibility be communicated from 
one person to another." He further states, *' that 35 white 
servants had been employed at the hospital without being at- 
tacked," and concludes by observing, " so few in the West 
Indies believe the doctrine, (contagion) that they may very 
safely be permitted to enjoy their own opinions — they cannot 
do much harm." 

The facts brought forward by Dr. Bone against contagion, 
are so numerous, that I am precluded by their bulk from 
affording them adequate space. 

Dr. Bone's son informs us that Inspector Green, principal 
medical officer in the West Indies in 1818, 1819, and 1820, 
(having the sanction of the authorities in England,) attempted 
to introduce the quarantine regulations then used at Malta, into 
the West India islands ; but these measures being strongly 
opposed by Dr. Bone, and the great majority of the medical 
officers on the station, the doctrine of contagion " died a natural 
death " soon after the departure of Mr. Green from the West 
Indies. J 

* Barbados. 

t The following remarks are by Dr. John Hunter — (" Observations on the 
Diseases of the Army in Jamaica, 1796:") — 

" In military physic the great improvem.ents to be made are not so much in the 
cure as in the prevention of diseases, which depends altogether upon a knowledge of 
their causes. 

" If disease arise from the air, contaminated by the foul ground of a camp, or the 
exhalations of a marsh, it can only be avoided by a change of situation, or by taking 
care not to come within the sphei-e of activity of such noxious causes. 

" Let it be supposed for a moment possible that a mistake should be made, and that 
the camp, or remittent fever, be not considered as proceeding from their proper 
causes, but believed to depend upon contagion. It is evident that complete destruction 
to all must be the consequence of such an error ; and, in medical history, there is 
reason to fear more examples than one of this might be produced. 

" By a contagious disease, is to be understood a malady arising from a poison 
generated in the body of the sick, which produces in others a similar disease. It is 
l>eculiarly characteristic of such diseases that persons of all ranks and descriptions 

O 



t&o Reports of Mi\ Hartle on Antigua, • 

So powerful were Dr. Bone's convictions before his departure 
from the West Indies, that, with a view to impress the truth on 
the minds of all those concerned, he sent a formula for the pro- 
duction of Yellow Fever, to the Army Medical Board,* of 
which the following is an abstract, — 

Take of soldiers lately arrived in the West Indies f any 
number ; place them in barracks in a low, wet situation, or in 
the mouth of a gully, or on the brink of a dry river, or on the 
summit of a mountain, and to leeward of a swamp, or of un- 
cleared ground, and where there is no water, or only bad water ; 
let their barracks be built of boards, or of lath and plaster, &;c. 

[Here follow a variety of other circumstances.] 
Let these directions be attended to in Trinidad, or even in Bar- 
bados, and especially when the air is stagnant, or charged with 
noxious vapours subsequent to long drought, the soldiers will 
"soon die, some of them yellow, some of them with black vomit." 

In Dr. Blair's late work on Yellow Fever edited by Dr. Davy, 
1850, p. 55, we also find a formula for giving that disease to 
nurses : — The way to give a Yellow Fever nurse the Yellow 
Fever was not by bringing him in close contact with the sick, 
but by discharging him or her from the hospital. After 
knocking about town for a few weeks and getting into the 
malarial districts, they would, it is likely, be brought to hospital 
as yellow fever patients. Several nurses discharged for bad 
conduct suffered in that way." 

I cannot pass over the official statements of Mr. Hartle, 
Deputy Inspector-General of Hospitals, who served in the West 
Indies, during a period of more than 30 consecutive years. His 
report for 1822 contains particulars of a most interesting kind, 
relative to the introduction of many cases of the Yellow Fever 
into the island of Antigua : in one place he remarks, " It is a 
pleasing renection, and a source of great gratification to me, 

are equally affected by them. Wherever they prevail the old inhabitants of a 
country suffer as mucla as those that have arrived lately. But this is never the 
case in the Yellow Fever, remittent fever, or even intermittent fever, for such as 
are seasoned to the country or climate suffer infinitely less than new comers. 

" But what may be considered as an experiment lan crucis, to prove the non- 
existence of contagion is, when the sick leave their usual residence, and go to other 
situations which are healthy, without spreading the disease. This constantly hap- 
pens in the remittent fevers of the West Indies ; for the good effects of changing 
the air of the towns for that of the mountains is so well known that it is very gene- 
rally practised ; but, certainly, without the slightest suspicion of any mischief 
arising from any contagion carried by the sick. 

'* When disease arises from a cause generally diffused, separation from the sick 
does not avail. Thus, ships of war have gene into a harbour in the West Indies, 
and have had no intercourse with those on shore, or A-^itli the crews of other ships, 
and yet in a few days the men have been seized with the prevailing fever in great 
numbers. 

" If these observations be applied to remittent or Yellow Fever there will be no 
ground for believing either to proceed from contagion." 

♦ Report of the epidemic in Trinidad, 1818. f See Appendix, No. IV., p. 381. 



Case of the Py ravius. 



187 



tliat, notwitlistanding 107 cases of Yellow Fever, as distressing 
and malignant as any 1 have before witnessed^ have been, by- 
three vessels, imported into this island since September, 1821, 
vre have not a single instance of any individual but those directly 
exposed to the local causes [ships^ having been attacked." He 
states that the sick received on shore from one of those ships 
( " Dasher *' transport) were attended by Europeans. Mr. 
Hartle's account of the Yellow Fever on board the Pyramus" 
frigate, which arrived in English Harbour from Barbados, on 
the 3rd of January, 1822, is highly important. The following 
are the principal facts recorded by this gentleman. Neither 
the officers nor men had been exposed to solar influence, or other 
exciting causes. One of the principal reasons assigned for the- 
breaking out of the disease was, that this ship had been " in- 
jected with coal-tar, which, with bilge-water, caused remarkable 
effluvia." The only ships on the station injected with coal-tar 
were the above, the Esk " sloop-of-war, and Dasher " trans- 
port, all of which suifered, the former and latter especially, with 
a similar type of disease. Yellow Fever, in its most malignant 
form."' He states that the crew of the Pyramus " were landed 
at English harbour, and the ship dismantled. When the lim- 
ber-boards were removed, the effluvium from the hold sur- 
passed everything which he had " ever before experienced." 
A boatswain looking into the hold from the lower deck, while 
an inspection by proper officers was going on, fainted, and 
passed afterwards through a formidable attack of the disease. 
Mr. Hartle himself, (I believe a native of the West Indies) 
who was one of the officers appointed to examine into the 
state of the ship, escaped with slight indisposition. He states, 
respecting^ the others, that every individual present at the 
opening of the holds and limber-boards was attacked by the pre- 
vailing disease.'* Although the frigate had been only six months 
from England, and was believed to have been a short time out 
of dock, large mud-boats of filth were removed from lier at 
Antigua, which was nine inches deep in the hold. The 
negroes employed in removing this mass were obliged to 
go on deck occasionally, so insufferable was the stencli, and 
three of them had the disease. The after-magazine, imme- 
diately^ under the gun-room, was found in the worst state, 
and this accounted, in the opinion of Mr. Hartle, for every 
officer s servant, ^and servant of the gun-room mess havino- 
suffered. Objections having been made to the removal of the 
crew beyond the dockyard, after their landing on the 15th, 
several cases occurred up to the 30th, in consequence of the 
men having gone on board clandestinely ; the crew were 
therefore encamped at some distance from the dockyard at 
Berkeley Fort, while a cleansing and thorough purification 

" o 2 



188 



Opinions of American Physicians. 



took place ; and, on returning on board, their health con- 
tinued good. 

America. 

Passing now to the American continent, my limits admit but 
of a few brief remarks. Up to the year 1793, almost all the 
medical men in the United States were believers in the commu- 
nicable nature of Yellow Fever ; but each epidemic diminished 
the numbers, so that, in 1825, according to an American com- 
mercial almanac, while 567 were against the doctrine of con- 
tagion, 28 only remained in favour of it, throughout the whole 
country. The public manner in which the celebrated Dr. 
Rush, once a believer in contagion, retracted his opinion, is 
matter of historical notoriety.* At New York the doctrine 
of contagion was long and ardently supported by Professor 
Hossack and Dr. Townsend, both of whom wrote much upon 
the disease. The facts which presented themselves to Dr. 
Beck in the course of the epidemic at New York (1822), 
caused his public retractation of faith as to contagion in the 
following year ;t and Dr. Townsend appears to have admitted^ 
that, of about 200 persons of all grades of the profession three 
or four only believed in the transmissible nature of Yellow 
Fever. "In 1793 the profession were almost unanimous in 
the belief of its contagious character, and no little courage was 
required to brave the storm an opposite opinion would have 
awakened. In this generation an equal unanimity prevails in 
the profession as to the non-contagious nature of the disease ; 
^ind he who advances the opposite doctrine seriously, is deemed 
no more worthy of notice, much less a refutation, than w^ould 
be an advocate at this time of the Ptolemaic system. §" The 
following statement from the pen of M. La Roche, French 
consul at Philadelphia, is extracted from a letter to a friend, 
20th July, 1830. " A friend of mine. Dr. Morrel, has lately 
tirrived from the Havannah. During a few days' passage three 
persons died of Yellow Fever on board ; and a fourth, taken ill 
on board, died in the New York quarantine establishment. 
The sick loere all cabin passengers, and received the germs of 
the fever in the port. The other passengers, who merely em- 

* Dr. Rush, [quoted by Sir W. Pym, 1st Edit., p. 208] says He he gs forgive- 
ness of the friends of science and humanity, if the publication of that opinion has 
had any influence in increasing the misery and mortaliti/ attendant upon that disease. 
Indeed, such is the paiii he feels, in recollecting that he ever entertained or propa- 
gated it, that it will long, and perhaps, always deprive him of the pleasure he might 
otherwise have derived, from a review of his attempts to fulfil the public duties of 
his situation." 

t New York Med. and Ph. Journ., No. viii., p. 472. See Addenda (S.), p. 238. 
% Chervin. — De I'Opinion des Medecins Americains, p. 11. 
5 Sea Amer. Journ. of Medical Sciences, August 1829, p. 523. 



Vera Cruz ; — Testimony of Humholdt. 



189 



barked at the moment of departure, witliout having waited 
in port, remained well, and that notwithstanding the inevitable 
contact arising from ]2 or 15 persons sleeping in a small cabin. 
Dr. Morrel and the other passengers were placed in quarantine, 
but during the time every body went to see them." 

Much interesting matter relative to the Yellow Fever epi- 
demics which have prevailed in America, may be obtained by 
consulting various pamphlets published by Dr. Chervin. 

That in North America the disease has not been propagated 
by the removal of persons labouring under it, even when 
carrying with them their bedding, &c., has been shown by 
observations made by medical men of upwards of 30 cities and 
towns, according to a report upon Dr. Chervin' s documents, read 
at the Academy. By those documents it appears that attend- 
ants of all classes on Yellow Fever patients constantly remained 
exempt from the disease, where the hospitals were placed out of 
particular local influences. This it appears was the case at the 
hospital at Bush Hill, near Philadelphia ; in that of Belle-vue, 
near Fort Stephens ; in that of the Navy at New York ; also 
in those of Norfolk, Baltimore, Providence, Newport, Boston, 
and New London. These most important facts are verified by 
Drs. Chapman, Redmond, Coxe, Mease, Lehman, Mitchell, 
Parish, Jackson, Perkin, Miller, Tucker, Thomas, Backe, 
Harlon, Coates, &c., of Philadelphia; by Drs. Anderson, 
Brown, Walker, Drake, and Osborne, of New York ; by Dr. 
Archer, of Norfolk; by Dr. M'Cauley, of Baltimore; by Dr. 
Weaton, of Providence ; by Drs. Turner and Waring, of 
Newport; by Dr. Townsend, of Boston; and Dr. Lee, of New 
London. Proofs to the same effect, collected in the West 
Indies, were laid before the Academy, by Dr. Chervin, in 1827. 

Dr. Pariset has admitted that the Yellow Fever is not con- 
tagious in America, — whether it had ever been so, or has 
ceased to possess that property."* 

With respect to America, this subject has perhaps been 
more fully entered upon by Humboldt than by any other 
person. In his Political Essay, (vol. iv.) he mentions that at 
Vera Cruz the idea of the importation of the disease from the 
Havannah and other places had been entertained ; but, by the 
facts which he furnishes, there seems to be no cause for doubt 
as to the disease being indigenous. The subject of contagion 
is investigated by this celebrated man in the spirit of philoso- 
phy for which he is so remarkable : we are shown to what an 

* " N'est point contagieuse en Amerique, soit qu'elle ne I'ait jamais ete, soit 
qu'elle ait cesse de I'etre." — Bulletin des Sciences Med., torn. xii. p. 126. 

Dr. P. F. Thomas, after an experience of 30 years at New Orleans, fully agrees 
as to this disease never exhibiting, under any circumstances, a contagious property. 
— See his Treatise on Yellow Fever, Paris, 1848. 



190 



Spain. —-Royal Edict at Madrid. 



extent one test of tlie communicable nature of a disease — that 
of taking people, whilst ill, into healthy districts — has been 
applied, and the result proved to be entirely against the doc- 
trine ; that not only at Xalapa, and higher up in the interior, 
but at the farm of Encero, a short distance from Vera Cruz, 
the disease is found to confine itself to the persons of those who 
may arrive with it in their systems, notwithstanding the freest 
intercourse with others.* Every observation made by Hum- 
boldt relative to Yellow Fever, is of high interest: one seems 
peculiarly deserving of attention ; which is, that although 
the disease usually prevails among the newly arrived every 
year at Vera Cruz, it never prevailed epidemically there be- 
tween 1776 and 1794, although the intercourse with the 
Havannah and other places where the disease continued to 
prevail, was quite free. He even says that during the eight 
years preceding 1794, " there was not a single example of the 
vomito^ although the concourse of Europeans and Mexicans from 
the interior, was extremely great, and the sailors gave them- 
selves up to the same excesses which are now laid to their 
charge. "f Such a fact is the more worthy of notice, as it does 
not appear to have depended on unusual atmospheric states ; 
and one can scarcely concede any degree of importance to the 
circumstance of the streets having been, for the first time, 
paved, in the year 1775, — seeing that the disease has recurred 
so often since 1794, — and has prevailed so frequently in the 
well-paved streets of St. Piere Martinique, of Cadiz, Gibraltar, 

Spain. 

To turn now to Spain: it appears that so far back as 1761 
(21st October), a royal edict was issued at Madrid, which set 
forth that all experience of the intercourse between the Havan- 
nah and Cadiz had proved that the black-vomit fever was not 



* " If the earth's surface did cot reach to considerable elevations within the tropics, 
the highly characteristic form of needle-leaved trees v/ould be almost unknown to 
the inhabitants of the equatorial zone. In common with Bompland, I have laboured 
much in the determination of the exact lower and upper limits of the region of 
Conifei-as, and of oaks in the Mexican highlands. The heights at which both begin 
to grow (los Finales y Encinales, Pineta et Querceta) are hailed with joy by those 
who come from the sea-coast, as indicating a climate where, so far as experience 
has hitherto shown, the deadly malady of the black vomit (vomito prieto, a form of 
yellow fever) does not reach. The lower limit of oaks, and more particularly of 
the Quercus Xalapensis (one of the 22 Mexican species of oak first described by us) 
is on the road from Vera Cruz to the city of Mexico, a little below the Venta del 
Encero, 2860 (3048 E.) feet above the sea. On the western side of the highlands 
between the city of Mexico and the Pacific, the limit is rather lower down, for oaks 
begin to be found near a hut, called Venta de la Moxonera, between Acapulco and 
Chilpanzingo, at an absolute elevation of 2328 (2480 E.) feet. 

" I found a similar difference in the height of the lower limit of pine woods on the 
two sides of the continent." — Humboldt's Aspects of Nature, vol. ii. p. 154. 

t Political Essay on the Kingdom of New Spain, vol. iv. p. 194. 

X Addenda (N.), p. 233. 



Opinions of Spanish Physicians. 191 



contagious. It would appear from this tliat tlie opinion of the 
court physician Cervo, sent to inquire into the nature of the 
Cadiz epidemics of 1730 and 1731, had been more regarded 
than that of Navarette, who attributed their origin to importa- 
tion from America. It seems curious that Arejula, when he 
wrote in 1806, should have committed the error of supposing 
the black-vomit of the Havannah, Vera Cruz, &c., to be a dif 
ferent disease from Yellow Fever. He appears in the dilemma 
of contending for contagion and importation under one deno- 
mination ( Yelloic Fever), while he admits that " our ships never 
brought the germs of the black-vomit, even though they had 
the disease on board when leaving our possessions ;" and (in 
America) " a succession of ages proved to the medical men 
that the disease was not communicable." This physician, with 
Drs. Coll and Amellor, also of Cadiz, made a declaration that 
the medical men commissioned to inquire into the causes of the 
epidemics of 1732 and 1734, pronounced it not to have been 
propagated by contagion. In all subsequent epidemics, a 
majority of the Spanish practitioners have favoured the doc- 
trine of importation and contagion ; but it would appear from 
the assertion of Professor Salva of Barcelona, in his Trozos 
ineditos, that the opinions of some had been influenced by 
political or other causes, for he does not hesitate to state, that 
when he applied for information, private opinions were ob- 
tained, in some instances, differing from those which had been 
publicly declared. A commission, instituted at Cadiz to in- 
quire into the origin of the epidemic of 1810, declared that in 
none of the six outbreaks which had occurred previous to 1805, 
could the origin of the disease be traced.* The importation of 
the disease alluded to by the Commission as having taken place 
in 1802, had reference to the disembarkation of about 500 cases 
from the fleet of Admiral Gravina on its arrival from the West. 
Indies. They admit that though many of the cases had the 
most characteristic symptoms, and though the communication 
with the city was free, " the disease did not spread, nor was it 
in any way communicated.'- It is also stated that though many 
cases were sent to the Aguada Hospital at Cadiz, from a French 
fleet, in 1807, with which a free communication was permitted, 
the disease did not spread. 

Many details connected with the origin of Yellow Fever 
epidemics in Spain up to the year 1820, are to be found in 
Hurtado's Nueva Monografia;^ in his Decadas f in Mr. 



* " En Binguna de estas epocas, exceptuada la de 1805 en que vino de fuera, se 
ha podido averiguar con exactitud, el origen de esta calamidad pnblica." " At none 
of these periods, except 1 805, in which it was imported, could the origin of this 
public calamity be determined with exactness." — Extract from the Report of the 
Commission. 



192 



Barcelona Epidemic (?/* 1821. 



Douglity's book ; * in the writings of Dr. Pariset ; and in 
various pamphlets published since 1827 by Dr. Chervin. 

The terrific epidemic at Barcelona in 1821, gave a new 
impulse to the question of contagion. The statements fur- 
nished by the medical Commission sent from France to make 
researches into the nature and origin of that disease, left a 
strong impression on the minds of many in the profession, 
favourable to its possessing a communicable property ; and the 
Histoire Medicale"" displays literary powers of a high order on 
the part of Dr. Pariset, who was at the head of the Commission. 
Dr. Chervin, however, followed Dr. Pariset, step by step, — 
not only at Barcelona, but through all parts of Spain where 
circumstances had been detailed respecting the propagation of 
the disease. 

The result has been, — such a collection of documents as had 
never before been laid before the public on any question of this 
kind. As elucidating a long-pending question of high import- 
ance to society, their value may be judged of from the opinion 
of the Academy of Medicine, which has been already referred 
to in the introduction to this Report. I regret that space will 
not permit my furnishing many valuable extracts from the 
works of this gentleman, published in 1827 and 1828. | We 
are there furnished with the statements of Dr. Pariset and 
others regarding the yellow-fever epidemics of Spain ; and it 
cannot but be admitted that Dr. Chervin has shown many inac- 
curacies had crept into those statements, and that the events 
warranted conclusions quite opposite to those which had been 
drawn. 

Dr. O'Halloran, who went to Barcelona to observe the epi- 
demic of 1821, had, previously to Dr. Chervin's visit, pointed 
out some of the extraordinary mis-statements of Dr. Pariset ; 
and in his book some interesting statements are furnished 
relative to occurrences at other points in Spain. 

At the same time with Dr. O'Halloran, the late lamented 
Dr. Charles Maclean visited Barcelona for the special purpose 
of examining all the circumstances connected with the above- 
named epidemic. 

Many who have studied Dr. Maclean's works, are of opinion 
that he was rather extravagant in some of his views, but the 
writings which he has left on the subject of this epidemic are 
quite sufficient to place him in a distinguished light amongst 
the profession. 



* " Observations and Inquiries into the Nature and Treatment of the Yellow or 
Bulam Fever."— London, 1816. Mr. Doughty served as stafF-surgeon in our army 
at Cadiz in 1810. 

t In the " Revue Critique," by Dr. d« Fermon of Paris, printed in 1829, a resume 
of the occurrences here spoken of may be found. 



Case of Buenaventura Puich, at Tortosa. 



193 



On the breaking out of tlie fever tlie population of Barce- 
lona was computed at 120,000. Within tlie walls of the town 
were found medical men, who, disregarding the evidence of 
their senses, closed the door against all evidence unfavourable 
to contagion, — adhering only to tradition. Indeed being often 
threatened by punishment from Government on the one hand, 
and by popular tumult on the other, they are obliged to 
yield to the most absurd errors, from which humanity becomes 
liable so cruelly to suffer.* 

But, from a certain number of the local medical men at Bar- 
celona, and of the foreign physicians then assembled, a goodly 
company was formed, resolved to show loyalty to the profession. 
From among these, a manifesto was issued, signed by ten 
Spanish physicians, two French, two British, and one American, 
to the eiiect that the disease was not contagious. f 

Dr. Piguillem, \7h.o states that he had been considered as the 
prince of contagionists^'' was amongst the number of those who 
subscribed ; having (together with 13 other Barcelona practi- 
tioners, who then also changed their opinions), adopted non- 
contagionist views some time after the disease had prevailed. 

Those who are interested in the subject may derive much 
information from perusing the work of Dr. O'Halloran, p. 67- 

An event remarkable in the history of Yellow Fever, occurred 



* Extract from " O'Halloran on the Yellow Fever of the South and East Coasts 
of Spain," p. 110. 

" Origin of the Yellow Fever at Tortosa in the year 1821. 

*' The disease, according to the latest official reports of the authorities and Board 
of Health, appeared in the person of Salvador Curto, a soap dealer, who sailed from 
Barcelona on the 1st of August, and arrived at Tortosa on the 4th." 

At p. 1 13, Dr. O'Halloran says. " The first marked case at Tortosa appeared in the 
person of a seaman, named Buenaventura Puich, belonging to the brig Ventura. After 
his entrance he held no communication with Salvador, nor with any of his family. 
When black vomiting, and other unequivocal symptoms of a malignant disease 
made their appearance, he was forcibly taken from his bed at eight o'clock at night, 
obliged to dress himself, and, with a rope around his neck, forcibly dragged by four 
armed soldiers, to a lazaretto in the country, at which he arrived after a march of 
three hours. The lazaretto, being unoccupied, was forced open, and the unhappy 
and helpless victim, without assistance, or even water to allay his thirst, was left to 
liis fate for the remainder of the bight withoui; a bed on which to repose, without 
an individual to whom he could speak, and without nourishment of any kind. He 
died on the 15th, with the usual symptoms of Yellow Fever, viz., yellowness, 
hcBmorrhages, black vomiting, &c." 

At page 117 he says, " The unexampled cruelty of the Board of Health towards 
Buenaventura Puich was not suffered to pass unnoticed. The military governor, 
Don Miguel de Haro, supposing that its conduct was a species of refinement on 
brutality, not sanctioned by laws either human or divine, remonstrated against the 
proceedings, and preferred a formal complaint to the Political Chief of the province, 
who, in all probability, treated it with little attention ; for the propriety or non- 
propriety of treating a fellow-creature, while under disease, with such brutality, has 
not hitherto been a subject of investigation in the province of Catalonia, at least if 
I am informed correctly." 

t Addenda, (O.), p. 233. 



Report of Arrutti, on 



at the port of Passages in the province of Gujpuscoa, a place 
known to many British officers, it having been the rendezvous 
for transports while our troops occupied the Pyrenees in 1813-14. 
It is difficult to give an idea of this singular port, situated at 
the bottom of the Bay of Biscay, and forming a sort of appendage 
to St. Sebastian's. The entrance is between precipitous rocks^ 
and is so narrow and oblique as to be with difficulty discovered. 
The town consists of one small street, placed on a shelf of rock, 
so narrow that it does not admit of the passage of carts, or, I 
believe, horses, while the base of the mountain of Olearso, is 
almost in contact with the houses, which are badly ventilated, 
filthy, dark, and crowded. 

We are informed by Dr. Arrutti, a physician resident in that 
part of the country, that, in June, 1823, a brig, named Donos- 
tiarra," sailed from the Havannah with a clean bill of health ; 
and that, having lost one man on her voyage (from ordinary 
disease, as far as was known), she obtained pratique at Corunna, 
after ten days' quarantine. She subsequently put into St. 
Andero, and arrived at Passages on the 3rd of August, with all 
on board healthy. This vessel had been employed in the trade 
of these ports. As she had been at Corunna and St. Andero, 
previous to her arrival at Passages, she was not here put in qua- 
rantine. 

The cargo, consisting chiefly of sugar and tobacco, was dis- 
charged ; and, for several days, a great many people went on 
board without any disease having broken out either amongst 
them or the crew. On the 15th, a custom-house officer, who 
had been several days on board, was taken ill, and died on the 
third day, black- vomit having appeared. This man was said to 
have been much engaged in the hold looking after contraband 
goods. On the 22nd, a man who had been in the hold, sur- 
veying the ship's timbers, likewise died. Some of the planks of 
one of this vessel's sides having been found greatly decayed, 
12 carpenters were employed in removing them, and six of the 
12 were attacked in quick succession. The opening in the 
ship commenced on the 19th, and, on the 23rd, the disease 
began to appear, in an unequivocal form, in the houses close to 
which she was moored. 

Dr. Arrutti proceeds to show that the disease did not extend 
beyond the houses opposite the ship ; that where others were 
attacked whose habitations were at a distance, it was occasioned 
by their having remained for some time within the space to 
which the malaria from the ship appears to have been limited, 
and the names and occupations of those persons are given. The 
heat was excessive, 28^^ Reaumur (about 96"" Fahr.), and the 
course of the wind favoured the conveyance of the noxious 
emanations from the ship to the houses : he gives the number 
of each house in which persons were attacked, and names 



Yellow Fever at Passages, 



195 



the points to whicli individuals labouring under tlie disease 
were conveyed, stating that notwithstanding the adjuncts of 
croicded, filthy^ and badly -ventilated habitations, the disease did 
not spread ; " whether they died or recovered, to none out of the 
focus was the disease communicated."* 

He observes, The inhabitants of Passages took the precaution 
of not making long delays in the focus of infection ; — they 
visited their relatives and friends, and performed towards them 
all the rights demanded by humanity and society, and the disease 
became extinct almost in its very origin, -j- It therefore 
results that this fever, examined according to the character it 
presents, does not offer a character of contagion from indivi- 
duals. It was afterwards discovered that many, evading the 
sanitary regulations, passed out without certificates of health, 
and took with them clothes, even i'rom the houses where people 
had died ; but, notwithstanding this, there was not the least 
spreading of the disease in the neighbouring country. If any 
deaths took place in Loyola, Renteria, or elsewhere, the disease 
in such cases had been contracted within the focus of infection. 

" If this disease had been transmissible by individual contact, 
what could have put a stop to its progress ? — no human power : 
for the people who had been in the closest contact with sick, 
convalescents, and clothes belonging to the sick, distributed 
themselves, when the cordon was about to be placed, at St. Jean 
de Luz, St. Sebastian's, Bayonne, and other places." 

Here then was an instance — not of Yellow Fever imported — • 
nor, rigidly, of the cause of Yellow Fever imported, but a 
development of the disease by the concurrence of a number of 
agents. On other occasions, it has been observed not to break 
out until vessels had been cleared of their cargoes ; and in this 
instance the great heat, reverberated as it must have been from 
the rock close to which the lightened ship was moored, may be 
easily understood as having been highly favourable to the extri- 
cation of a noxious principle from her decayed planks. J 

In another account of this outbreak, by Dr. Montes in the 
14th vol. of Hurtado's Decadas, its origin is attributed to sources 
within the town itself, independent of the ship, as publicly de- 



* Page 70. 

t It appears that the ship was burned and sunk. 

X The origin of this disease at Passages, from sources on board, has been admitted 
by Dr. Audouard of Paris, a professed contagionist. — See " Kevue Medicale,' ' 
Sept. 1824, p. 83. 

This geatleman, who carried his views of contagion even to intermittent fever, 
was a physician in the French army in that part of Spain, and cordons were of 
course not forgotten ; but in advocating his opinions on the occasion he says (" Kevue 
Medicale," vol. iii. p. 224), " Nevertheless it must be confessed that the contagion 
at the Port of Passages was not so manifest as at Barcelona ;" and leads to the 
conclusion that the first circumstances connected with this outbreak went to prove 
contagion, the last, the contrary. So that on the whole Dr. Arrutti's statements 
must be received as those most worthy of credit. 



196 



Sierra Leono — Case of the Caroline.^* 



clared by Dr. Zeubeldia ; and we are told tliat a similar disease 

Erevailed tliere in 1780 and 1791.* There is no discrepancy, 
owever, in the statements as to the disease not having been 
propagated from person to person ; though Dr. Arrutti seems 
to apply the word contagion j to the extension of the disease 
within the limits of the noxious emanations from the ship. 

Africa. 

In the same year in which tlie Fever took place at Pas- 
sages, another circumstance occurred, which has been fre- 
quently alluded to. 

By an official Report, drawn up and published in 1824^ by 
Dr. (now Sir William) Burnett, one of the Commissioners of 
the Medical Department of the Navy, it appears that in the 
early part of the preceding year a fever made its appearance 
at Sierra Leone in a form different from the usual remittents 
of the country, and stated to possess symptoms characteristic 
of Yellow Fever. The alleged importation of this disease by 
the merchant-ship " Caroline," is completely refuted in that 
Report ; and at page 24 an extract from the gentleman at the 
head of the medical department at Sierra Leone is given, in 
which it is stated, that from all the evidence which could be 
procured in the colony, there was reason to conclude that the 
disease was non-contagious. A curious circumstance, to which 
there is perhaps no parallel except that which occurred under 
my own observation in the West Indies, is related by this 
gentleman, viz., " that European females and children were 
perfectly exempt." 

On the 23rd December, 1823, a statement was circulated by 
Sir Gilbert Blane, calculated more than any thing which had 
previously appeared to prove the importation and subsequent 
communication of Yellow Fever. It appears that the " Bann," 
sloop-of-war, left Sierra Leone for the Island of Ascension at 
the latter end of March, 1823; that a malignant fever prevailed 
among her crew, during and for some time after the voyage ; 
and that, on the eighteenth day after her anchoring at Ascension, 
a disease alleged to have been similar, and in some instances 



* M. Bally, in his Report on the Yellow Fever at Passages, in 1823, states, 
pp. 5, 6, that similar epidemics were said to have prevailed there in 1780 and 
1791 after arrivals from the West Indies, and also that the French troops in 
1808-9, and the English in 1813-14, suffered much from fever at the same place. 
" Here," [in the latter instance] " there were no suspicions as to the American 
typhus ; it was the typhus of Europe, that destroyed a great many victims in the 
hospitals."— See Addenda, (P.), p. 23.5. 

_ t I had been long acquainted with Dr. Bobadilla, at Gibraltar, and considered 
him a believer in contagion, in the sense of direct or indirect transmission from 
one person to another ; but, to my surprise, he assured me that, at an hospital in 
Los Barrios, some years previously, he explained to everybody how the attendants 
on Yellow Fever patients were not more liable than others to attacks. 



Case of the " Bann' at Ascension. 



197 



accompanied with black vomit and yellow skin, broke out in the 
garrison of that island whicb consisted of 35 men, besides 
women and children. 

It appears by Sir William Burnett's Report, that an error 
had crept into Sir Gilbert's statement regarding the health of 
the crew when she left Sierra Leone ; but what is of much 
greater importance to the argument we find altogether omitted 
by the latter, though suj? plied by the former, viz., " On reference 
to the journals of medical officers who, at different times, had 
charge of the garrison before the appearance of the late epidemic, 
not only has dysentery and hepatitis been very prevalent, as 
well as occasional attacks of fever, but likewise a fever called 
the bilious remittent,* in the year 1818, attacked almost every 
man on the island, which the assistant surgeon attributes to an 
unusually wet turtle season, when the men are much exposed 
by watching at night to turn these animals. 

Moreover there is, in the journal of Mr. Robert Malcolm for 
1818, a case of this disease, which commenced on the 1st of 
June, and terminated by death on the next day, with all the 
symptoms of yellow suffusion and black vomit, &c , which are 
said to characterize the Yellow Fever ; and havino- shown this 
case to the surgeon of the ' Bann,' now in London, he declares 
it to be exactly similar to the cases of fever which lately 
proved so fatal in the ' Bann,' and amongst the marines at 
Ascension." f 

Here then, whatever might have been the nature of the dis- 
ease which prevailed in the " Bann " and at Ascension, in 1823, 
we have evidence of the existence of the same disease in the island^ 
and about the same time of year, in 1818, without the remotest 
suspicion of its having been then imported. 

This, on the obvious principle that what may in one year 
happen on a small scale, may, from an extension of the cause, 
happen on a larger scale in another, greatly enhances the force 



It seems remarkable that thougli perfectly known for some time past that the 
true Yellow Fever has been prevalent this year (1850) on the coast of the Brazils, 
(Bahia, Pemambuco, and Eio Janeiro), and it being also ascertained by returns to 
Somerset House for the quarter ending 3lst March, from H.M. ships " Cormorant," 
" Tyne," and " Crescent," that most malignant cases ( Yellow Skin, Black Vomit, 
Hcsmorrhayes,) prevailed in each of these ships— ^^e term Yellow Fever does not 
once appear on the official returns /—they all appear, under the head of " Bilious 
Eemittent," so clear, I presume, do the remissions appear in those latitudes. If we 
consult the army statistics of the mortality among the troops in the West Indies 
over a period of 20 years, the adoption of the same classij&cation at Jamaica will 
also seem remarkable, for while we know, that within the period mentioned the 
troops in that island have suffered more than in any other of the West Indies 
TWENTY CASES ONLY of Yellow Fever appear on the face of the returns during the 
20 years; the convictions of the various medical officers stationed there, leading 
them to a belief that the term Bilious Remittent, so frequently used in difFeren*t 
parts of the world, might better convey some of the prominent and more constant 
phenomena of the disease. — See Appendix. No. III., p. 282. 
t Page 10, 



198 Report of Sir Wm. Burnett on the J' Bann." 

of the concluding part of Sir William Burnett's sixth position, 
" that a disease similar to the fever in the ' Bann ' might have 
prevailed in that island though the ' Bann ' never had any com- 
munication with it."* He tells us that *'the principal medical 
officer at Sierra Leone has come to the same conclusion in his 
offiicial Report and I suspect that, greatly augmented as the 
facts bearing upon the question of contagion have been within 
the last few years, the majority who have paid attention to 
Yellow Fever will come to the same conclusion, rather than 
admit as a propter hoc that which, as far as the evidence goes^ 
was simply a post hoc. 

Sir William, though favourable to the belief of importation 
on this occasion, leaves the question open, and furnishes all the 
details to enable the profession to form an opinion. He points 
out erroneous statements as to the health of the island from 
the period of our occupying it (1815) to the epidemic year, 
1823. He says, ^' Out of 130 cases of disease which are recorded 
in these journals, 12 died and 19 were invalided; and though 
perhaps all the fatal cases are inserted in the journals, it is 
well known that those documents seldom contain more than a 
third of the cases which actually occur." He tells us that, 
according to the medical gentlemen in charge of the garrison, 
although at a period immediately preceding this event, " they 
were on the whole very healthy, yet they were by no means 
exempt from disease."! He admits, " that after a most careful 
inquiry, it is impossible to trace the fever in question directly 
from the ' Bann,' to any individual of the garrison of Ascen- 
sion :"J and indeed it appears that the first person attacked 
was not one of those known to have been in the ship or in con- 
tact with the sick, but a boy, respecting whom " it is neither 
known nor believed that he had any nearer communication 
with the sick of the ' Bann ' than passing daily at no great 
distance from the tents to feed his father's poultry, and he was 
never on board that ship." § 

The tents alluded to, about 500 yards from the garrison, 
were occupied as a hospital for the accommodation of the sick 
from the " Bann," and all intercourse icas interdicted. He informs 
us that the restrictions on the intercourse between the ship and 
the garrison had not been much attended to, several persons 
having been on board after the landing of the sick ; but that, 
from the time of the boy's illness, ''every proper precaution 
was taken for preventing the extension of the disease to the 
outposts ; notwithstanding which, six men, two women, and 
seven children, were taken ill at Springs, but fortunately none 
at the Green Mountain, though one of the men belonging to 
that post had been on board the * Bann.' " 



* Page 11. Page 52. % Page 53. § Page 14. 



Outbreaks oj the Disease in Ships. 



199 



I shall only add that the surgeon of the " Bann," an excel- 
lent and intelligent officer/' ascribed the disease to the long 
stay of the ship in port at Sierra Leone, where the crew had 
been much exposed to the sun's rays in refitting her rigging, 
&c. ; and that when this vessel had been on the Jamaica 
station, in 1821, a fever, with yellow skin and black vomit, 
appeared among a party of 40 prisoners, put on board for a 
passage ;* which disease, according to the surgeon's journal, 
did not extend to the crew, nor could he trace a single instance 
of disease to contagion," although "the smallness of the vessel, 
and other circumstances, would not admit of a separation 
between the sick and ship's crew." 

That there were, on a prima facie view of the irruption of 
the fever in Ascension, reasonable grounds for suspecting the 
agency of contagion, there cannot be a doubt ; but it is far from 
established by evidence^ that the one was the cause of the 
other ; and many will probably join in believing that to admit 
the transmission of this disease from individuals, woidd be 
illogical, and nothing short of admitting that to be vrai which 
is shown to be only vraisemblable.\ 

Ships, 

Considering the mass of evidence before the public, it would 
be quite idle to deny the spontaneous breaking out of Yellow 
Fever on board of ships in various situations : one of the best 
authenticated instances is that of the Bedford," in Gibraltar- 

* Page 47. 

t The outbreaks of Yellow Fever on tlie Western Coast of Africa cannot be 
passed over without reference to the work of Mr. James Boyle, R.N., M.C.S.L., 
colonial surgeon to Sierra Leone, entitled "Account of the Western Coast of 
Africa," London, 1831. 

This gentleman's book displays gi'eat merit in several respects. We have from 
Mm, speaking of the epidemic of 1829 a1 Sierra Leone, that " Peculiar season is the 
immediate cause of epidemic fever ;" — " that occasional cases of Yellow Fever are 
to be met with every year in Sierra Leone (230), — " that all fatal cases were 
under the influence of one general cause, malaria-" — (268), " that it appears that 
in Sierra Leone the disease was not contagious ;" — " and that although very many 
hundreds of individuals, from various parts of the colony, visited the market of 
Freetown every day, not one case of the disease occurred in any of the villages." 

Mr. Boyle (at 238) refers to what he considers the unfounded nature of the 
report of the Yellow Fever of 1829, being imported into Sierra Leone by H. M. 
ship " Eden," though he seems to admit that the disease might have been contagious 
on board that ship. 

And, at p. 266, we have the following copy of a document which was posted, 
by direction of the Governor, in various parts of Freetown : — 

" Freetown^ Sierra Leone, May 27, 1829. 
" "Whereas a report has been in circulation throughout the colony that the 
fever now prevailing is of a contagious character, his Honour the Lieutenant- 
Governor, has deemed it expedient to call for the opinions of the principal medical 
officers upon this subject, and they, whose names are hereunto affixed, do declare, 
that there is not the slightest ground for the rumour that contagion exists in the 
colony. 

(Signed) " J. Boyle, Colonial Surgeon. 

M. Sweeny, Deputy-Inspector 
W. Ferguson, Surgeon^ R.A. C. C " 



200 Cases of the CarnatiorC and Blossom.^' 



Bay, in 1794, of wliicli tliere are official records at Somerset 
House. 

In tliat year Yellow Fever was not prevalent in the garrison, 
and the crew arrived in health from the Mediterranean on the 
24th of August. On Sunday the 6th of September, the crew 
having been mustered, every man answered to his name ; but 
in the course of the week 130 were sent to the hospital, with 
fever possessing the characteristic symptoms : 1 1 died before 
the 24th of September, and others were left dangerously ill on 
the departure of the ship that day. 

In this case the only feasible cause assigned was the shifting 
of the shingle ballast, with the object of trimming her. The 
disease did not extend beyond the crew. 

The fact of the sailors of the British ship " Carnation," when 
put on board the French brig *' Palinure," by which she was 
captured, in 1808, having been attacked with the disease, 
would admit of the explanation of their having, in common 
with the previous cases in the " Palinure," originated from 
sources within that ship. 

The following is among the more recent instances of the 
spontaneous irruption of black-vomit fever on board ship. 

H. M. ship ''"Blossom" had been employed in the summer 
of 1830 in surveying the Honduras coast ; and in the month 
of August the disease commenced, which obliged the captain 
to go into Belize harbour, to obtain medical assistance from the 
garrison. Forty-eight cases were received into the military 
hospital between the 11th and 30th of August: two officers and 
eight men died, and "these cases were attended with black 
vomit," according to assistant-surgeon Watts, who forwarded 
notes of the circumstances in his official return to the Army 
Medical Board 24th September, 1830. Mr. Watts adds that 
the disease did not extend to the other ships, or to persons on 
shore. 

In a report from Dr. Lindsay, surgeon of the Blossom," to 
his department, he says, " I am of opinion that the cause of the 
present illness arose in the ship herself." 

Among the naval surgeons of practical knowledge in this 
disease, I do not find many supporters of the doctrine of conta- 
gion. The following is from Mr. Mortimer, while serving as 
principal naval medical officer at Barbadoes : " We do not 
allow the fever of the West Indies, commonly called 'Yellow 
Fever,' to be at all infectious in any of its forms or stages- 
We have never known of an instance of its communication to 
patients at the several naval hospitals, whilst under cure for 
other complaints, though such patients have never been inter- 
dicted, on the contrary encouraged to offer every additional 
aid for the s^reater comfort of their sufferino^ brethren." * 



* See Communication to Commissioners of Transports, Med. Chir. Eev., vol. 



Cases of the Eimjalus'' and Eclair.^' 201 

Among writers on Yellow Fever Dr. Jolm Wilson, R.N., is 
deservedly celebrated. The following instance of British 
cruelty or ignorance, contrasted witli Danish generosity, is 
recorded by him ; he says,* — 

*^We are told by the advocates of contagion that measures 
restricting or preventing intercourse never can do any harm. 
In the following case — a case which I could scarcely have 
believed to have happened at Barbados in J 819 — it is pretty 
clear that it did do harm. 

" In October, 1819, Her Majesty's ship ' Euryalus' anchored 
at Barbados from Bermuda. She had a number of fever cases 
on board, and two men died after her arrival at Carlisle Bay. 
So strongly did the fear of contagion operate on the minds of 
men in power, that the hospitals were shut against the sick of 
the ship. It was intended to have taken measures for putting 
her in quarantine, but the safer method was loisely thought to 
be that of getting quit of her altogether. She accordingly 
went to sea, the sickness increased, and she put into the Danish 
island of St. Thomas, where the governor, actuated by the ordi- 
nary feelings of humanity, unfettered by prejudice, gave "orders 
for the immediate reception of the sick into hospital. Seven 
men were landed at first, and numbers afterwards as they 
became affected. They were treated by Danish physicians ; 
most of them recovered, and when the work of kindness was 
completed, they returned to their ship. It was never believed 
or alleged that they communicated disease to a single person 
on shore. ' Look on this picture, and on this.' " 

On a parallel with the foregoing were the disgraceful occur- 
rences which took place with reference to the ^' Eclair" from 
Boa Vista in 1845 ; whea the sick were denied an asylum out 
of the reach of the malignant poison which was destroying 
them, even on our own shores. 

It cannot be expected that all instances of the appearance 
of Yellow Fever on shipboard, should be noticed. In 1726 
great havoc was made in the fleet of Admiral Hosier, lying off 
Portobello, by a disease alleged to have been Yellow Fever. In 
1741, Admiral Vernon's fleet suffered from it off Carthagena, 
(S. A.) In 1742, the disease broke out in the same fleet off 
Portobello. In 1776, the Spanish ships "Angel" and " Astrea" 
suffered from the disease on their way to the West Indies. It 
broke out in the squadron of the Spanish Admiral Solano, in 
1783. In 1785, in the Spanish ship "San Ildefonso." In 1793, 
in the " San Lorenzo," one of the ships of the Spanish Admiral 
Aristobal, bound from Cadiz to the West Indies. In the same 



♦ Memoirs of West Indian Fever, 1827, page 77. See Addenda, (Q), p. 236. 

P 



202 



Evidence from Chervin, Arejula, ^^c. 



year in tlie squadron of the Spanisli Admiral Borja. In 1794, 
on board H. M. sMps Bedford" and Kent." In 1795, 
on board tlie " Hussar" frigate on tbe American coast. In 
1801, on board tlie ship " Penelope," carrying Irish emi- 
grants to New York. In 1802, in a French fleet from Taren- 
tum, bound to St. Domingo. In 1803, on board the '"Hibbert" 
on her passage from Portsmouth to New York. In 1802, in the 
fleet of the Spanish Admiral Gravina. In 1807, in the 
^^Phebe" in the West Indies. In the same year, in a French 
squadron in the bay of Cadiz. In 1808, on board the French 
brig of war, Palinure." In 1813, in an English vessel which 
arrived at St. Domingo from England, as stated by Dr. Pinedo. 
In 1814, in a flotilla of Spanish revenue cruisers ('^ ^Marc?a- 
costas''). Since this period it appeared in the following ships 
of war, on the West India station, — " Iphigenia," Wasp," 
" Tribune," " Sapphire," " Scout," Tamar," " Bustard, " 
" Thracian," Rattlesnake," " Lively," Isis," " Scylla/' 
" Pylades," and " Ferret," and many others, particularly in 
the Eclair,"* " Growler," and other steam ships. 

Effects of Migration. 

The following proofs are given from Dr. Chervin of the 
advantage of migration from localities where Yellow Fever 
takes place. 

In his ansYvrer to Dr. Lassis, Paris, 1829, p. 13, he shows that 
the good effects of migration have been repeatedly displayed. — 

During the epidemic of 1800 at Cadiz, 14,000 persons left 
that city when the disease became suspected. t These people 
fled to the country, where they remained free from the epi- 
demic, 'I while of the 57,499 who remained, 48,520 were 
attacked and 7,387 died. 

On the 1st September, 1803, the population of Malaga was 
51,745, of which 3,730 migrated and escaped the reigning 
malady, while out of 48,015 who remained in the city 16,517 
were attacked, of which 6,884 lost their lives. § 

In the month of July, 1804, the population of Malaga 
was 36,008, exclusive of the military garrison, prisoners, and 
other persons. Of these 4,548 fled, and thereby secured them- 



* See Addenda, (E.), p. 237. 

Much valuable information in reference to the spontaneous production of YcUo-w 
Fever on board ship is furnished by M. Forget in vol. x,, Medicine Navale, Paris, 
1832, p. 195, et seq. 

t Arejula Breve Descripcion de la Fiebre amarilla, p. 434, " Yo conozco un 
solo medio seguro y eficaz de libertarse del contagio, que es irse pronto lejos, y 
volver tarde," p. 339. 

X p. 230, loc. cit, § Salva's Trozos ineditos, p. 12. 



on the Advantages of Migration. 



203 



selves from attacks, -while of tlie remaining 31,460 — 18/787 
were attacked, of wliom 11,486 died." * 

''While these things occurred at Malaga similar circum- 
stances took place at Alicant, where the inhabitants amounted 
to 13,957; 2,110 left for the neighbouring country, where they 
remained free from attacks, while of 11,847 in the focus of the 
disease 6,971 suffered and 2,472 died.f 

" All who know the Spanish peninsula must be aware of the 
exposure to privations under which emigrating populations 
must suffer in calamitous times. Yet, in these cases, they 
obtained security from the pestilence by which their neighbours 
who remained behind were swept away. 

At 20 other places besides those which I have mentioned, 
similar occurrences took place with similar results. 

*' While the Yellow Fever epidemic afflicted the inhabitants 
of Tortosa in 1821 ; 5,000 persons departed for the villages 
of Roqueta and Jesus, on the other side of the Ebro, and the 
neighbouring country, where they remained free from the 
disease which carried off about 5,000 within the walls of 
Tortosa. J 

" On the same occasion the inhabitants of Asco and Mequi- 
nenza, both situated on the Ebro, were also preserved by esta- 
blishing themselves under tents and olive trees, and though 
suffering privations, those who were at a distance from the 
river were not attacked. § 

" At Palma, in the island of Minorca, the seat of a terrible 
epidemic in 1821, had migration not taken place the results 
would have proved niuch more calamitous. 

''Let us hear what the medical commission, which went to 
Barcelona, said upon the subject. 

'* 'On the 15th September the superior authorities, civil and 
military, left the town for Valdemosa, a village situated three 
leagues from Palma. The citizens following their example 
made a precipitate retreat to the country beyond the walls, and 
the migration was so considerable that of 32,000, 12,000 only 
remained. It was necessary to raise funds, secure means of 
maintenance, and build huts . in the open country, and two 
encampments were formed at the foot of Mount Belver, half a 
league from Palma. 

" ' All the healthy poor were assembled, all who, for want of 
work, were starving, and all who had strength removed thither, 
and thenceforth security was found from the disease or, as 
Dr. Pariset expressed it, they escaped the contagion. " The 



* Arejula, 4th table in his book, 
t Arejula, loc. cit. 5th table. 

X See petition to the king from the municipality of that city. 
§ Histoire Medicale, &c. (Pariset), p. b*l. 

p2 



204 



Inutility of Quarantine Laics, — 



12,000 wlio remained in Palma, after tlie emigration of tKe 
rest, had 7,400 sick and 5,341 deaths." ' * 

It was calculated tliat from Barcelona in 1821 about 80,000 
persons fled, and, except some who departed with the disease 
already upon them, or who were on the eve of being attacked, 
all remained exempt from the reigning malady; f though 
subjected, as Dr. Lassis well knew, to great privations, for he 
says, ' These refugees from Barcelona experienced all sorts of 
vexations.' The inhabitants of the neighbourhood, even those 
of the highest mountains, influenced by the fear of imaginary 
contagion, adopted precautions of the most arbitrary nature. 
They might have been seen exercising towards them measures 
contrary to the most sacred rights of humanity, and, by such 
conduct, furnished a deplorable example of superstitious ig- 
norance in which the routine of sanitary [i. e. quarantine] 
measures had placed the people." 

" In spite of all the sufierings of the fugitives from Bar- 
celona they remained free from the epidemic. While, from 
about 70,000 persons in the city, near 10,000 deaths took 
place."J 

" In 1823, when the Yellow Fever broke out at the Port of 
Passages 3,000 persons took flight, and it was fortunate that 
this measure limited the deaths there to only 40. § 

On that occasion, as at Barcelona, in 1821, after the flight 
of the people, a few only, who left the tov/n ill, had the disease." 

On the necessity of migration on the outbreak of Yellow 
Fever, I will now merely add a few words from the Baron 
Dupuytren, in his Report to the Academy of Sciences in Paris, 
1825. 

We should therefore regard as incontestable the prin- 
ciple which consists of evacuating immediately the places 
where Yellow Fever is declared to be, and everything for this 
purpose should be adopted. The utility of such a measure 
must always justify its rigorous execution." 

Quarantine Laws. 

After the details given in the foregoing pages, I am not per- 
mitted to doubt, but that those who have followed me through 
them will have arrived at the conclusion that Quarantine Laws, 
in reference to Yellow Fever, are not only unnecessary, but 
cruel and unjust, — often producing great privation and sulFer- 
ing, — frequently, instead of checking the progress of the 
disease, increasing the number of victims by confining people 

* Hist. Med. p. 70. f Ibid, p. 25. 

' X Ibid. p. 134. 

^ Arruti Tradado de la Fiehre amarilla, p. 75. 



their Cruelty and. Absurdity. 



205 



to sliips or infected localities on sliore, thereby rendering 
escape from the real source of the disease impossible,- — and, 
finally, acting most injuriously on commercial intercourse. 
But perhaps I cannot exhibit the necessity for the abrogation 
of those laws in a stronger light than by giving the following 
passage from a work on Yellow Fever,''' by Dr. Reider, of 
Vienna, who made this disease his particular study, and, for 
this purpose, made several voyages to the West Indies and the 
American Continent, where, like Dr. Chervin, he was enabled 
to observe every particular characteristic of the disease. He 
says, p. 106, — 

All these circumstances are calculated to fill with horror 
the breast of every feeling and honest man ; and we are really 
obliged to offer violence to ourselves in not giving vent to our 
indignation against the partisans of contagion, who yet desire 
to continue to defend their erroneous opinions, and who, to this 
day, have used all their efforts to make obscure and disfigure 
the subject, to the great detriment of truth; — who have never 
ceased to deceive governments, which think it their duty, v/ith 
regard to this disease, to surrender themselves to the judgment 
and knowledge of medical men, — who have never ceased to 
describe it as contagious, and have induced those authorities to 
adopt, with respect to it, the most false and contrary measures, f 
and to neglect the suitable, prophylactic, and preservative 
means, and others which might have put an end to the dis- 
astrous epidemics of this disease; — thus it is they have always 
acted contrary to truth, to the interest of governments and of 
humanity." 

In conclusion, I beg to quote the following extract from a 
document furnished to the American Commission at Albany, 
1845, J by Dr. Reece, of New York, who says, — 

" I am of opinion that the oppressive features of our Qua- 
rantine system should be reckoned among the relics of bar- 
barism which an enlightened Legislature should make haste 
to abrogate for the sake of our character as a people. 

There is no pretext for the perpetuation of a system 
founded in ignorance, and fruitful only in public and private 
injustice, cruelty, and wrong," 



* Memoire sur la Fievre Jaune, Vienna, 1828. 

f "Twenty-six persons were detained in quarantine of observation at the 
' Venta' of the Capuchins of Reinteria, for having communicated with Ajarbe, the 
carpenter, who died there [of yellow fever] on the 31st August, and the time which 
had been prescribed by the Sanitary Board of Bayonne having expired without 
any of these persons having been attacked, I consented to their being set at liberty 
on the 28th September."' — Andoiiard, de la Fievre Jaune au port du Passaae, 1823. 

I Addenda (S.), p. 238. 



206 



Localities in Spain at which 



ADDENDA. 



Letter (A.) 

Tliat Yellow Fever prevailed to a serious extent in the 48th Regiment, in the 
autumn of 1798, appears hy the following portion of a letter from the late 
Staff-Surgeon Hill, dated 13th June, 1832 : — 

" The 48th regiment having- returned from the West Indies a complete 
skeleton, were completed by recruits from the different supplementary corps to 
the number of 1,100 strong, with which it immediately embarked on board the 

Calcutta" Indiaman the 1st September, 1798, at Lymingion, and arrived at 
Gibraltar the following month (October) ; previously to the regiment em- 
barking there had been a detachment on board, and two or three cases of small 
pox occurred ; the ship had been fumigated and whitewashed, but nevertheless 
a few cases of small pox were debarked at Gibraltar on the arrival of the regi- 
ment at that fortress ; in all other respects the men were healthy, although 
much crowded on board ship, and such was the state of equipment that the 
men appeared in their different county militia uniforms, not having had time 
to fit on the proper uniform clothing prior to leaving England. 

" Soon after the arrival of the corps at Gibraltar several cases of yellow or 
bilious remittent fever made their appearance, which increased rapidly and 
proved highly fatal. Dr. Harness, physician to Lord St. Vincent's fleet 
(afterwards one of the Commissioners of the Sick and Hurt Board), declared 
the fever to be precisely the same he had seen in the West Indies, and re- 
quiring the same treatment ; indeed the fever was of the same type, but in a 
more aggravated form than I have repeatedly [since, J. G.] seen during the 
autumnal months, particularly when it was the bad practice to encamp regi- 
ments on the Neutral Ground under pretence of keeping them healthy. 

" It is to be remarked that the young recruits were the only sufferers, not 
an officer having been attacked, most of whom had lately returned from the 
West Indies, but amongst the subalterns there were several that had never 
before been out of England. 

" The regiment on its arrival was quartered in the King's bastion, a bomb 
proof casemate, and not sufficient to properly accommodate half the battalion, 
the hospitals were equally bad and crowded. 

" The other regiments in garrison did not suffer from fever more than usual, 
and the disease was confined solely to the 48th, and no apprehension or dread 
was entertained of the fever spreading either amongst the military or civilians, 
neither were there any precautionary measures resorted to, for in those days 
the antisocial doctrine of ideal contagion was not in existence. 

(Signed) Wm. Hii.l, 

^' Dejntty Inspector of Hospitals.''* 
[ Vide accompanying Plan of Gibraltar.'] 



The following list of cities, towns, and villages of Spain, in which Yellow 
Fever is admitted to have appeared since 1800, may not be uninteresting to 
the profession ; but in many of these places the disease was confined to cir- 
cumscribed localities where the Sanitary conditions were notoriously defective, 
and did not extend to the mass of the population. 

In Andalusia. 

Cadiz. — Built at the extremity of a narrow neck of land, extending about 
6i miles into the sea. Lat. 36. 32. Number of houses 4,020 : population 
53,600. 



Yellolo Fever has prevailed. 



207 



St. Fernando. — In the Isla de Leon, near Cadiz. Situation low. Population 
3,400. 

Puerto de Sta. Jf«na.— Situated opposite Cadiz. Low. — Population 17,500. 
Puerto Peal. — In Cadiz Bay, opposite that city. Situation low. Population 
5,000. 

Rota. — On the coast, one league from Puerto Sta. Maria. Population 
7,997. 

Chipiona ; lat. 36. 40, — On a rock on the coast, near the mouth of the Guadal- 

quiver, IJ- leagues from San Lucar and 3 from Cadiz. Population 500. 
Ayamonte; lat. 37. 13. — At the mouth of the Guadiana, near the frontiers of 

Portugal, in a sterile country. Population 6,300. 
Medina Sidonia. — In bishopric of Cadiz, and 5 leagues E.S.E. of that city ; 

4 leagues from the sea. An old town built on a high hill. Population 

9,300. 

Vejer.~ln bishopric of Cadiz, on a very high but cultivated hill, at a short 
distance from the sea, opposite Cape Trafalgar. Population 8,172. 

Los Barrios. — A small village, situated in the mountains, about 14 miles W. of 
Gibraltar, on the road to Cadiz. 

Algeciras. — Situated in the Bay of Gibraltar, and opposite the latter town ; 
little elevated above the level of the sea ; behind it are high ranges of moun- 
tains. Houses 2,200 ; population 9,800. 

Gibraltar ; lat. 36. 6. 42. — Population, including military (and comprising the 
district called South, as well as the territory beyond the walls near Neutral 
Ground), '22,000. 

Ximena. — In bishopric of Cadiz, about 20 miles from Gibraltar, in a N.W. 

direction ; situation on a hill. Population 6,000. 
Paterna de la Rihera. — K small town situated at the foot of the Xerez moun- 
tains, in the bishopric of Cadiz. Population 1,500. 
Xerez de la Frontera] lat. 36. 41. — Four leagues N. W. of Cadiz, on a hill 

in a fertile country. Population 31,000. 
San Lucar de Bar amedM ] lat. 36. 47. — At the mouth of the river Guadal- 

quiver ; situation low. Population 16,500. 
Arcos de la Frontera. — Situated on a very high rock, in bishopric of Seville, 

10 leagues north of Cadiz. Houses 3,060 ; population 10,000. 
Villa Martin. — Archbishopric of Seville, on the river Guadaleta, 13 leagues 

from Cadiz and 12 from Seville. Population 2,700. 
Espera. — Archbishopric of Seville ; situation low ; near a small river which joins 

the Guadaleta opposite Arcos, 10 leagues from Cadiz. Population 2,900. 
Lehrija. — Archbishopric of Seville, in a plain 2 leagues from the river Guadal- 

quiver. Population 6,700. 
Utrera. — Archbishopric of Seville, 2 leagues from Seville ; situated between 

two hills; streets wide and paved. Population 1,105. 
Alcala de Guadayra. — Archbishopric of Seville ; a small town situated on a 

hill. Population 5,000, 
Seville; lat. 37. 24. — On river Guadalquiver ; situated in an extensive plain, 

24 leagues N.N.E. of Cadiz. Houses 12,055 ; population 100,000. 
Carmona; lat. 37. 28. — Archbishopric of Seville, on a hill 6 leagues to the 

E. of that city. Population 18,000. 
Moron. — Archbishopric of Seville, at the foot of the chain of mountains called 

Sierra de Ronda, 10 leagues N.E. of Seville. Population 7,500. 
Fcija; lat. 37. 31. — Archbishopric of Seville, in a plain on the western bank 

of the Xenil, 6 leagues before its junction with the Guadalquiver, in a 

fertile country. Population 34,727. 
Antequera. — In a plain between Grenada and Seville ; it is built partly on a 

rising ground ; streets straight and wide ; 26 miles N.N.W. of Malaga. 

Inhabitants 13,000. 

Cordova; lat. 37. 52. — Situated in a plain near the Sierra Morena, on the 
river Guadalquiver; distant from the sea 70 miles in a direct line, 46,600 
inhabitants. 



208 



Localities in Spain (continued). 



Montilla. — Archbishopric of Cordova, 6 leagues to the S.E. of that city; 

situated partly on a hill. Population 12,000. 
Espejo. — Archbishopric of Cordova; on a plain on the river Guadajoz, 5 

leagues Irom Cordova. 
La Rambla. — A town in the archbishopric of Cordova. Population 7,800. 
Corlotta. — Archbishopric of Cordova, 5 leagues S.W. of that city. A large 

village ; population about 2,000 ; 26 leagues from the sea. 
Aguilar. — A town in archbishopric of Cordova. Population 11,000. 
Granada. — Situated near the Sierra Nevada mountains, at an elevation above 

the sea of 927 feet ; about 16 leagues from Malaga, and about 31 miles in 

a direct line from the sea. Population 80,000. 
Malaga; lat. 36. 43. — At the base of a range of hills ; a very remarkable hill 

on its eastern side. About 7,000 houses; population 52,000. 
Velez Malaga. — Situated at about 14 miles to the E. of Malaga, on the slope 

of a hill, 2 miles from the sea, on the river Velez. Population 14,000. 
Alhaurin. — A small village on an eminence, within a short distance of Malaga. 

Population about 400, 
Cliurriana. — A small village between Alhaurin and Malaga, situated on an 

eminence. 

Alhaiirinejo. — Situated about \^ league irom Malaga ; a village. 

Vei^a. — Bishopric of Almeria, situated about 3 miles from the sea, in a plain. 
Population 8,000. 

JEl Palo. — A village distant about a league to the E. of Malaga, 

El Borge. — A small town, bishopric of Malaga. Population 1,200. 

Honda. — Situated in the midst of a range of mountains of that name, at a very 
great elevation above the sea ; distant from Gibraltar 60 miles N. Popula- 
tion about 18,000. 

Also La Carraca, Cliiclana, Las Cabezas, Sn. Hoque, Mairena, Estepa, 
Cart-ana, Los Falacios, Villqfranca, El Archal, Dos Hermanos, Tribujena, 
Bornos, Zara, Almeria, and Ubrique. 
Total number in Andalusia, 59. 

In Murcia. 

Murcia ; lat. 37. 58. — Situated on river Segura, 9 leagues N. of Carthagena. 

Population about 35,000. 
Carthagena; lat. 37. 35.^ — Territory rather unfertile. Population about 

30,000. 

Jumilla — Bishopric of Carthagena, 10 leagues from Murcia, at the foot of a 
hill, 40 miles from the sea and 65 miles N.W. of Carthagena. Population 
8,000. 

Molina. — A small village, 2 leagues from Murcia, in a plain, on the river 

Segura. Population about 1,300. 
Archena. — Situated 4 leagues N. of Murcia, in a plain at the foot of a range 

of mountains near river Segura. Population about 800. 
Ojds. — Five leagues N. of Murcia, in a narrow valley on the river Segura. 

Population 300. 

Ricota. — Five leagues and a half N. of Murcia, in a plain at the foot of a 
range of mountains, and distant a quarter of a league from river Segura. 
Population about 1,000. 

Alberea. Yelar, Alcaria, Mazarron, Las Aguilas, Totana, Lorea, Ziera^ 
Villa-nueva. 
Total number in Murcia, 16. 

In Valencia. 

Orihuela; lat. 38. 8. — Situated in a plain, near a range of mountains on river 
Segura, and distant from the sea 14 miles. Population 25,500. 

Guardamar ; lat. 38. 15. — A small sea-port, at the mouth of the river Segura, 
Population about 4,000, 



Bohadilla, on the Gibraltar Epidemic of 1810. 209 



AUcant ; lat. 38. 20. — Situated in a fertile country, on the sea-coast. Houses 

4,500; population 21,000. At the foot of a high hill. 
Penacerrada. — A small village, 1 league from Alicant, consisting of 42 families, 

158 inhabitants. 
St. Juan. — A small village in the neighbourhood of Alicant . 
Elche, Alcantarilla, Palmar, Lehrilla^ Albama, Tabarca (a small island). 
Total number in Valencia, 11. 

In Catalonia. 

Barcelona; lat. 41. 21. — Situated in a plain, in an extensive bay, having on 
its western side a remarkable mountain. Houses 19,000; population about 
120,000. 

Barcelonetta. — Situated near Barcelona, and in the same bay, distant from 

latter city a quarter of a mile. 
Tarragona; lat. 41. 7. — Situated at the mouth of the river Francoli, at an 

elevation above the sea of 760 feet. Population 11,000. 
Tortosa; lat, 40. 48. — Situated on the left bank of the Ebro, 4 leagues distant 

from the sea. Population 13,000. 
Asco. — A small town on the right bank of the Ebro, partly on a hill, 13 leagues 

from Tortosa. 300 houses ; population 1,300, 
St. JEloy, Escala, Torreuela. 

Total number in Catalonia, 8. 

In Aragon. 

Mequinenza. — Bishopric of Saragossa, at the confluence of the rivers Ebro and 

Segra ; distant from the sea in a direct line 40 miles. Population 1 ,469. 
Nonaspe. — A village near Mequinenza, on the small river Nonaspe. Popula- 
tion about 1,000. 
Number in Aragon, 2. 
In Old Castile 1, — »S^. Andero. 
In Guypuscoa 1, — Passages. 

Total number of places in Spain, 96. 
In the great majority of these places the disease prevailed to a limited extent 
only. 

Letter (B.) 

Copy of a Letter from Dr. Bobadilla to Dr. Gillhrest, November 2, 1829. ' 
''Sir, 

I HAVE received your favour of yesterday's date, in which you request 
some details regarding the occurrences in Gibraltar connected with the Yellow 
Fever which prevailed in the year 1810. 

" We were directed by Government to report all suspicious cases ; and, 
agreeably to my duty, I gave in the names to Dr. Pym (whom we had then 
as chief medical officer) of individuals at three places in the city which I knew 
of : one of these was in a house opposite the meat market belonging to 
Mr. Boschetti ; another in the green market, and the third in Bonastero's- 
lane, in the house of Mr. Beloty. I reserved my opinion as to the true cha- 
racter of the diseases at the time, leaving that to him to do in preference ; but, 
notwithstanding this. Dr. Pym came to my house at midnight of the same day, 
in order to obtain my opinion ; and I then declared to him that they possessed 
the characters of the true Yellow Fever, and he immediately took the steps 
which I judged advisable, and which we had been in the habit of adopting in 
Spain, by which, and a north wind which lasted seven days, and which purified 
the atmosphere completely, the disease ceased, as I had foretold Dr. Pym it 
would, on the first day of the setting in of the wind. 

" I remain yours, &c., 
(Signed) JoAQum Bobadilla." 

" A true copy of the English translation in the possession of Dr. Gillkrest. 

Henry T. Maxted." 



210 



O'Halloran on the Dockyard Cases 



I think it of importance to notice respecting the Yellow Fever at Gibraltar 
in 1810, stated by the Superintendent of Quarantine as having been cut short 
by his having placed " a cordon of troops round the infected part of the South 
District for fourteen days ;" that the spot surrounded by the cordon (see p. 30, 
Pym's 2nd Edit.) was by no means the only one where Yellow Fever cases 
appeared, for it is shown by Mr. Amiel, that outside the cordon the wife of 
Assistant-Surgeon Martin died of the black vomit. Cases also appeared at 
Cooperage Barracks (then plan. Letter P.), among the 7th Veteran Battalion, 
besides five or six cases at other points. 



Letter (C.) 

Extract from O'Halloi'an " on the Yellow Fever on tlie South and East Coasts 
of Spain." P. 167, et seq. 

" There are some points in the work of Dr. Pym, to which I must call the 
attention of the reader, I am sorry to be under the necessity of doing so, but 
such palpable errors as appear in his work, on subjects which essentially con- 
cern the welfare of mankind, imperiously demand that I speak the truth in the 
manner in which it has impressed me. Were I not to do so, and to do it with- 
out reserve, I should hold myself culpable in the extreme. I am ready to 
answer, under every possible penalty, for the fundamental correctness of what 
I state ; and I now proceed to state it in as concise a manner as possible, 
leaving the reader to draw his own conclusions. I am responsible for the fact. 

Dr. Pym, at page 55 of his book, [1st Ed.] alluding to the fever of 1813, 
which prevailed at Gibraltar, states — ' Of 500 persons confined to the dockyard 
during all the time of the sickness, there was not an instance of one of them 
being attacked, although this was, of all others, the most likely spot for marsh 
effluvia to exist, and which, during the fever of 1804, suffered equally with 
other places, in consequence of the communication not having been cut off'.' 

" [At page 139] ' The labourers belonging to the naval works have been 
kept in strict quarantine in the dockyard, very near the spot where the disease 
showed itself in 1810; and if there is a situation in Gibraltar favourable to the 
generation of marsh miasmata it is there ; and in 1804, it shared the fate of 
the other parts of the garrison ; yet those people this year have continued 
healthy, as well as another party of inhabitants, who established themselves in 
Camp Bay, and cut off' all communication with the infected.' " 

Dr. G Halloran observes — 

" The perusal of the foregoing quotations in the work of Dr. Pym struck me 
forcibly on my arrival at Gibraltar in the present year. I thought the immunity 
of the dockyard from fever in the year 1813 a singular circumstance, and one 
which strongly operated against the doctrine which I am inclined to embrace. 
I had not doubted the assertions of Dr. Pym and Mr. [W. W.] Eraser ; for, 
from their rank in the service, the one being at the head of the Health Office 
in London, and the other at the head of the Medical Department in Gibraltar, 
it was reasonable to expect information of authenticity, for their opportunities of 
attaining it exceeded that of others. It happened, however, by accident, that a 
medical gentleman, who saw the epidemic of 1813, observed, in the course of 
conversation, that fever prevailed to some extent in the dockyard of that year ; 
and that, by an application to Mr Buck, who was secluded with the others, and 
who is now the superintending officer in charge of the establishment, particular 
and authentic information might be obtained on the subject. 

" I applied to Mr. Buck, and the information which I have obtained from him 
and his head clerk is the following ; it may be depended upon as officially 
correct. 

" An order was issued on the 18th of September, 1813, for preventing inter- 
course between the dockyard men and the inhabitants of Gibraltar. 

* The whole of the officers and clerks are hereby directed to repair to the 



at Gibraltar^ in the Epidemic ^1813. 



211 



yard this evening-, as all communication will cease with the garrison at daylight 
to-morrow morning. 

(Signed) Percy Fraser, Commissioner.'' 

To the respective Officers. 



''Deaths and Cases in the Dockyard at Gibraltar, in the Autumn of 
1813, from the 18th of September, to the 23rd of December. Taken 
from the books. 

Deaths. 

'^1. Marion Thomas, shipwright, sent to the lazaretto, where he died. 
2. The sister of Mr. Pontez, a sawyer, died on the 20th of September, in 
the boat-house loft. This woman was supposed to have introduced the disease. 

" 3. Antonio Mattas, (date not mentioned), died of a very short illness in 
the boat-house. Hosmorrhages from the nose, mouth, &c., preceded his 
death. 

4. Mrs. Hamlyn, died in the block store. 
" 5. Juan Mirobas, died 24th of September, on the careening wharf. 
" 6. Francis Guerero, labourer, died 6th of October. 
" 7. Antonio Sowsa, died 20th of October. 

" 8. Herbert's child, died on the sail-loft on the 20th of October. 

Sick. 

William Walker Harder; Samuel Fursman ; William Bernard; Robert 
Monk ; William Betts, sent to lazaretto ; William Ancel ; William Whitehead ; 
Patrick Thoneo ; Joseph Caprella ; Rafael Pons ; Antonio Fiel ; Mrs. Canter ; 
William Salm.on; Robert Newman; Mrs. Denham ; Diego Dalmuda." 

" The communication between the sick and healthy was uninterrupted. The 
number of persons secluded, according to Mr. Buck's account, who examined 
the books in my presence, amounted to 170. Dr. Pym makes it 500. 

" The people of the dockyard were released from quarantine on the 24th of 
December, 1813. 

" The above list of deaths, sick, &c., in the dockyard at Gibraltar, during the 
period alluded to, is, (I blush to say, for the honour of the profession) authentic* 
The fact cannot be doubted, and the truth of it might have been, it is presumed, 
ascertained by reFerring to almost any insignificant individual now in the dock, 
yard. The impressions which are made upon those who are present in the 
lamentable scenes of sickness, the perpetual dread of the impending attack, the 
solicitude to avoid it, and the impossibility of avoiding it, as confined within a 
narrow barrier, may be supposed to have left traces in the memory which are 
not soon obliterated. It, therefore, could not have been difficult for this head 
of the medical department to have satisfied himself of the actual fact, in a range 
so limited as that of Gibraltar; and thus to have saved his own mortification, 
and the public evil that may have arisen from his erroneous report. I cannot 
divine how the error alluded to can be explained, or what can be adduced in 
extenuationof a mistake so palpably flagrant as this.f The evidence now given 
is conclusive against the truth of the assertion of Dr. Pym ; and the careless- 



* The dockyard authorities conclude a certificate given to Dr. O'Halloran, 29th 
August, 1823, " The truth of the assertion as to deaths having taken place there 
cannot be doubted, and the list of sick which you have given falls far short of the 
number affected ; but the dread of being sent to the Lazaretto, and being separated 
from their friends and relations, caused the sufferers to conceal the disease in 
many instances." 

t To ray utter astonishment I found this statement repeated in the second edition 
of Sir W. Pym's work (p.34), printed in 1848, though he had been twice in Gibraltar 
after the error had been thus publicly exposed. 



212 



Gillhrest, Smith, and Hennen, 



ness with which he made such report, or the motive which induced him so to 
modify an important fact, that it has no resemblance to truth, cannot fail to 
meet with reprobation from honest men, whatever be the doctrines which they 
adopt. It does not belong to me to seek for excuses for other men's errors or 
oversights ; but it may probably be suggested, that the dockyard was not within 
the control of the military commander, and that this was the cause that the 
statement was incorrect. This excuse, I may add, if such be made, would not 
be valid, for some of the sick at least were accommodated in the lazaretto, 
which was under superintendence, whether they recovered or died. " 



Letter (D). 

Extract from a Letter from Dr. Gillkrest to Dr. Hennen, 4th September j 
1828, as to the origin of the Gibraltar Epidemic. 

" As far as human judgment can go, I think that at least a high degree of 
probability arises out of the evidence, such as I have heard it stated, respecting 
the drains ; but, on a question where so much difference of opinion has always 
existed, it may be well not to leave the question [of its being imported by a 
certain ship] entirely unheeded : and as all such points become matters of 
history, I may perhaps be excused by you for suggesting-, if you have not quite 
made up your mind, that a medical inquiry of a formal nature should be insti- 
tuted ; I may add, this seems to be the opinion of others." 



Extract from a Letter from Dr. Smith to Dr. Hennen, on the same sid)ject. 

" At the same time I cannot help thinking if there is the slightest founda- 
tion for this belief [in the importation of the disease by the Swedish ship 
' Dygden,'] it merits the most serious consideration, and before determining on 
the origin and nature of the present epidemic, if I may yet call it so, the most 
minute and impartial investigation ought to be instituted on this important sub- 
ject. On the decision of this question depends, in a chief degree, the nature 
of the means which it may be considered advisable to recommend for eradi- 
cating the disease, as well as the chance of safety which it holds out to the 
healthy by a timely and efficient separation from the infected*" 



Letter (E). 

Copy of a Letter from Dr. Hennen, Inspector- General of Hospitals, to Sir 
George Don^ on the appearance of the first cases of the Epidemic. 

" Inspector's Office, Gibraltar, 
August 29, 1828. 9 o'Clock, a.m. 

" Sir, 

" In reference to my letter of this day's date, I have now the honour 
to inform your Excellency that I have minutely inspected District No. 24, in 
company with Mr. Wilson of the Civil Hospital, Mr. Woods, the medical 
officer attached to that district, and other staff officers, and it is with much 
regret I have to state to your Excellency, that in almost every step I took in 
that district, I had reason for surprise, not that fever had broken out there, but 
that it had not extended farther. 

" It would lead me into matters not immediately connected with professional 
points, were I to enlarge upon all I have seen and heard during my inspection 
of that district, but the conclusions to which I am irresistibly led are as follows : 
— and I beg to claim your Excellency's special attention to them, as the only 
means for preventing a repetition of those horrors which occurred in this gar- 
rison at the period of your Excellency's happy arrival in 1814. 



on the first Cases in 1828 at Gibraltar. 



213 



" From whatever causes it may have proceeded, the pauper population is 
dense to a degree incredible, except to those vv'ho have seen it. In sheds, 
without ventilation, without drainage, and generally composed of the slightest 
materials, in tiers of beds, as close as in a crowded transport, numerous indivi- 
duals sleep. They go to their work at an early hour, and return at gun-fire, 
locking up their miserable places of nocturnal shelter during the day, and 
leaving them saturated with the steams of their bedding, their food, and the 
overflowing receptacles of their ordure. * The detail would be too disgusting 
to be entered into, but I most respectfully submit to your Excellency the in- 
dispensable necessity of sweeping [away] the whole of those sheds, which 1 
have every reason to suppose are unauthorized by the Government, and are 
solely the offspring of the most sordid avarice ; so confident have been the 
owners of these sheds at their permanence, that some of them are actually 
covered with sheet iron, a measure which, while it may tend to put money into 
the pockets of the owners, by preserving the wretched sheds, must especially 
conduce to render these places hothouses of contagion. 

Might I presume to offer my opinion, a committee of civilians, military 
and medical officers, should be immediately appointed to inquire into the state 
of all the temporary buildings through the garrison, and if they are deemed 
incompetent for the purpose of human accommodation, and with a risk to public 
health, that they may be forthwith razed to the ground, as I understand many 
of them have heretofore been, although subsequently from increased demand 
on the part of the lower orders, for shelter, they have sprung up with incredible 
rapidity, contrary to the spirit of those admirable police regulations which 
were laid down by your Excellency. 

" Although my recent observations have led me to a positive conclusion with 
regard to the state of the District No. 24, I cannot doubt that all the other 
districts are comparatively in a similar state. 

" 2nd. Without wishing to implicate any individual in the charge of neglect 
of duty, I would suggest that the police Serjeants of districts should receive the 
most positive orders to attend especially to the duties connected with the 
cleanliness of the places committed to their care. On this subject I shall only 
say, that a most respectable medical officer has stated to me, that he rarely sees 
a police serjeant perambulating his bounds, and in truth the veracity of his 
assertion was confirmed to me by more senses than one. Under this head I 
may ipention that 1 had repeated evidence, that your Excellency's orders, with 
regard to placing barrels, baskets, &c., for the reception of dirt, in commodious 
situations, for removal by the scavenger, appear in many cases to have been 
altogether neglected. 

" I shall feel it both a duty and a pleasure to accompany any committee that 
your Excellency may think proper to appoint, to examine into the multiplied 
causes which at present threaten the public health. I shall lose no opportu- 
nity of visiting every part of this garrison, and shall report to yom Excellency 
every circumstance which, in my opinion, may tend to the preservation of the 
public health. 

" (Signed) J. Hennen, M.D. 

" Inspector of Hospitals" 

In his official report for the year 1826, p. 145, Dr. Hennen, speaking of the 
Epidemic of 1814, says, — 

" These cases first appeared on the hill side, considerably above the old 
nidus of fever (Boyd's Buildings,) many of them occurred at Cavallero's Build- 
ings, situated close to Arengo's Gulley, they lie about the highest of any houses 
on the Rock, but are now in a very different state to what they were in 1814. 
At that period Cavallero's rivalled Boyd's for filth, there were neither drains 
nor necessaries, and the inhabitants consisted of nearly 300 of the lowest order 
of Portuguese; at the distance of about 150 paces was established the grand 
depot of the garrison filth, the stench of which was intolerable, and the swarms 
of flies that infested the whole neighbourhood almost exceeded belief." Men- 
tioning other points with regard to this part of the town, he adds, "can we 
then wonder at the appearance of fever here 



214 



Memorandum hy TV. Sweetland, Esq, 



Letter (F.) 

The following statement was furnished to T. Jones Howell, Esq,, by the 
late W. Sweetland, Esq. 

" Memorandum relative to the Swedish Ship ' Dygden,' H. G. Gerle, Master, 

" This vessel arrived here from Havana on the 28th of June last, after a passage 
of forty-seven days. She was partly, perhaps one-third, laden only, and had 
nothing on board but sugar and logwood. She sailed with a crew of sixteen 
persons, including the captain, all in good health. On the 27th of May a 
seaman died, and on the 1st of June another, being fifteen and nineteen days 
after her departure. The clothes and bedding of these persons were thrown 
overboard with the bodies. The disease of which the men died did not extend 
itself to any other of the crew, w^ho all continued healthy up to the time of her 
arrival, which, as above stated, was on the 28th of June, consequently twenty- 
seven days had elapsed from the day of the last death to that of her anchoring 
here. 

" The ship was visited by Dr. Hennen, the officiating Inspector of Health, 
who made every necessary inquiry respecting the state of health of the crew, 
and satisfied himself there was nothing whatever to mark her case beyond that 
of any ordinary arrival from the West Indies, and she was accordingly placed 
under a quarantine of forty days, being the period fixed by Proclamation for 
ships on board which deaths have occurred from fever, and whenever such are 
not occasioned by accident or by violent means, it is always assumed that fever 
is the cause of them. 

" Soon after the ' Dygden's ' arrival it was written from hence to Spain, and 
also, as I have been informed, to Italy, that she arrived with the Yellow Fever 
on board, and had lost several men from that cause, in consequence of which 
information the government of Alicant extended the quarantine on Gibraltar 
from eight to sixteen days. 

" The knowledge of these and other circumstances induced me to put Dr. 
Hennen on his guard against the omission of any little form, and in consequence 
the Doctor regularly paid a visit to the * Dygden' whenever his duties .called 
him afloat. Nothing occurring to excite suspicion of her being unhealthy, at 
the expiration of twenty days, as directed by the law, the ship was permitted 
to commence the discharge of her cargo. Two Health Guards were placed on 
board, under whose superintendence the linen, and clothes, beds, and sails 
were aired every day, that is, a part of them each day ; and the ship and crew 
fumigated twice. Her quarantine expired on the 6th of August; she was 
released, and sailed on the 12th of that month bound to Cadiz. 

" The injurious reports by which the ' Dygden' had been assailed during her 
stay here, had preceded her to Cadiz, where she was refused admittance, by 
reason, as I was informed, of her having lost men while under the performance 
of quarantine in this Bay ; nor was the impediment removed but by the pro- 
duction of a certificate from hence in contradiction of the report. 

" It was then stated, that the cause of the refusal of the government of Cadiz 
to admit the ship was, that she had arrived there in a sickly state. To this 
was opposed an official certificate from thence of the perfect state of health on 
board her at that period. 

" It may, perhaps, be unnecessary to record any of the minor reports w^hich 
were propagated to the prejudice of this unfortunate ship ; suffice it to say, the 
greater part of them were contradicted, by those even who were said to be the 
authors of them ; and many were so exceedingly absurd as to need no refutation. 
People, I imagined, were tired of the subject, and many days passed without 
my having heard anything about it. 

" About the latter end of August, or very early part of September, a fever 
appeared in the upper part of the town, as was said, near a drain, which was 



on the Reports concerning the Dygden.^^ 



215 



stated to be choked and to emit a pestiferous stench, declared by the principal 
medical officer to be quite sufficient to induce such a disease without other 
agency, and this opinion was espoused by many gentlemen supposed to be very 
capable of judging of its probability. The general belief was, however, that 
the disease had not originated here, and this doctrine was taken up by the 
whole mass of the population, and facts were eagerly sought for to demonstrate 
the importation of the fever. 

" It was now whispered about, that six men had died on board the ' Dygden' 
during the performance of her quarantine ; that one of the Health Guards, on 
landing from the ship, had carried the fever to his house, which was situated in 
the infected district, where he had died ; and that his sister, who had washed 
his linen, was lying at the point of death under an attack of the same disease. 
These persons being perfectly well known in the town, their appearance was a 
sufficient contradiction of the tale. 

It was next stated, that a woman who had washed the captain's linen had 
been one of the earliest victims to the pestilence, and that she, and not the sister 
of the Health Guard, had washed the clothes of the latter. This story obtained 
credit for a time. 

" It was, I think, nearly a month after the first appearance of the epidemic, 
that the Health Guard here spoken of was attacked by it ; his case was among 
the worst which had occurred ; he considered himself, and was so considered 
by his medical attendant, to be on his death-bed, and under that impression he 
made a declaration to this effect, viz. : — 

^' That on going on board the ' Dygden' he and his companion found the crew 
to consist of fourteen persons, the master included, all in perfect health. That 
they were most particular in the observance of their instructions by reason of 
two men having died on board [on the voyage] ; causing the sails to be loosed 
and aired, and the clothes of the captain and crew to be aired every day during 
their stay, which was eleven days, causing the hammocks and clothes of the 
seamen to be washed. The most perfect health was enjoyed by every one, the 
men attending every day at work, and at meals eating heartily. That they 
caused the ship to be fumigated twice, together with the captain and crew. 
That he, the declarant, landed on the 6th of August, and the captain having 
expressed a wish to buy some neckerchiefs, he accompanied him to a shop 
where the purchase was made, and from whence the said neckerchiefs were 
taken to the Health Guard's house, and made by his sister, who lived with 
him. And he concludes his statement by a declaration that the woman who 
had washed his clothes was in good health, and lodged near him in the Civil 
Camp, from whence his declaration is dated. 

" The above statement was confirmed in all its parts by the Health Guard on 
his recovery, fully corroborated by his companion ; and this very important 
fact stated by both, ' That it was the custom on board the ' Dygden' for the 
crew to wash their linen twice a week, and that the captain had a handy servant, 
who not only washed but even ironed his linen ; that he had no linen washed 
here, and when asked if he wished a laundress declined having one, saying he 
would have his linen washed in Cadiz, where washing was cheaper ;' so that 
there can be no doubt of his not having had any clothes washed in Gibraltar. 

" A gentleman having told me that he had reason to believe one of the Health 
Guards on board the ' Dygden' had said that the captain had told him that all 
his crew had been attacked at the Havana by a fever called the ' Dengue 
Fever.' 

" He explained, on being questioned, that the captain had told him of the 
existence of such a fever in that city, which was very general, lasting four or 
five days, and then passing away without killing the patient, but that none of 
his crew had been attacked by it. 

" I know not what new ground of attack is preparing, but it certainly is not 
abandoned, though at present the proof of introduction by the ' Dygden' is, 
it would seem, rested on the declaration that fever issued out of the sugar boxes 
on their being opened here ; whether any of them were so or not is more than 



216 Bill of Health of the ' ' Dygden!'— Opinions 



I can say, or if the Yellow Fever can be packed up and let out of a box of 
sugar. My opinion, founded on long experience, is, that the disease w e are 
cursed with is not the Yellow Fever, but that which we had here in 1804, 
1810, 1813, and 1814. 

" Gibraltar, the 10th of November 1828. 

(Signed) " Wm. Sw^eetlaj^d." 



Translation of the Bill of Health of the Ship " Dygden." 

" We, the members of the Board of Health, Don Antonio Gaston y Navar- 
retti, Knight of the Royal Military Order of St. Hermenegildo, wearing the 
crosses of distinction of the Marine and Chilana, Captain of a frigate in the 
Royal Navy, and likewise of this Port, by his Majesty's nomination ; Doctor 
Ciriaco de Arango, deputed chief magistrate by the most excellent Senate ; 
and Doctor Don Lorenzo Hernandez, Physician, Honorary Consulter of the 
Royal Armies, and first Physician President of the Royal Medical Council of 
this always most faithful city of St. Christopher of the Havana, and ever loyal 
island of Cuba — 

" Do hereby certify, that by the grace of God our Lord, at the sailing from 
this Port for that of Gibraltar, of the Swedish ship " Dygden," Captain Gerle, 
this city and its neighbouring towns are free from all plague or contagious epi- 
demic disease, as likewise the said captain with the fifteen men of his crew, are 
in a state of perfect health, according to the muster by her roll, and in com- 
pliance with the last order, we give the present Bill of Health.* 

(Signed) Ciriaco de Arango, 

Aktonio Gastox, 
Dr. Lorenzo Hernandez." 

Havana, May 9, 1828. 



Letter (G). 

Replies of several Medical Officers to some of the Queries sent out from the 
Army Medical Department in London^ after the termination of the Epidemic 
of IS2S at Gibraltar. 

Staff-Surgeon Dow, Brevet Deputy-Inspector of Hospitals. 

' ' Do you consider this disease as originating in Gibraltar^ or as an impoi'ted 
disease ? State the facts on which your opinion is founded. 

" I consider this disease as originating in Gibraltar. [Does not give the facts 
upon which this opinion is grounded.] 

" In what respects does the late epidemic differ from the bilious remittent 
fever of the same place at certain seasons of the year? 

" The principal difference between the late epidemic and the bilious re- 
mittent of the same place, appears from the remissions of the latter disease, and 
in the greater severity and rapidity with which the symptoms in the former 
run their progress^ especially with reference to its fatal tendency. 

" Do you consider the disease contagious, i. e. propagated by contact, and did 
the very latest cases appear to have been contagious f 

" I know of no well-authenticated case of this disease being propagated by 
contact. 



* It is to be observed, that by reference to old Bills of Health, in the possession of 
the Captain of the Port of Gibraltar, whenever cases of Yellow Fever appeared casually 
at the Havanah, the circumstance had been invariably stated on the back, and the 
Members of the Board saw that on the Bill of Health of the " Dygden " there was no 
such note ; so that this document proved not only that the Yellowj Fever did not reign 
epidemically at the Havanah, but that no cases occurred sporadically when the " Dygden" 
lay there. 



of Medical Officers on the Origin of the Epidemic. 217 



" Do i/ou consider tlie disease epidemic, propagated by the general vitiation of 
the atmosphere of the Rock ? 

I consider the disease to have been propagated through the general vitiation 
of the atmosphere of the Rock, because the disease did not attack the inha- 
bitants who sought refuge on board ship and on the Neutral Ground, The 
atmosphere of a sick room is not exempt from the general vitiation, at the same 
time I do not deny that in crowded, iilthv, ill-ventilated apartments, persons 
are much more liable to be attacked with fever than thej would be in clean, 
thoroughly-ventilated apartments, even should the latter contain sick people. 
I also consider the higher parts of a situation no security, provided the means 
of ventilation and of cleanliness are proportionably deficient. 

'* Had malaria or the effluvia from marshy places any ^ and ichat, influence in 
the production of this disease? 

I do not tlrlnk the effluvia from the marshy places of the coast, in the 
vicinity of the Rock, had any influence iu the production of the late epidemic. 
What were the sequelce of this disease; visceral obstructions, ague, &'c. ? 

^' Hepatic derangement and general debility causing protracted convales- 
cence, have been noticed as the most frequent sequels of this disease. 

Were other acute diseases observable during the epidemic, — particulai-ly in- 
termittent fever ? 

" I did not observe any case of intermittent fever during the epidemic ; and 
a few cases of dysentery and diarrhoea appear to have been admitted into the 
94th Hospital during the early part of the epidemic." 

STArr SuKGEox Dix, dated Gibbaetae, 1829. 
What icas the state of the public sewers, and icas any marked difference 
observed in the cleanliness or filth of the streets, houses, ^^c. ?- — Report at large 
on this subject. 

The state of the public sewers has been in a state of progressive improve- 
ment for some years, and no cause of sickness appeared in them, which did 
not exist in former years ; though I suppose that the sewers do in some mea- 
sure tend to a general vitiation of the atmosphere, as some of these leading 
from the upper roads, are, I believe, very near the surface, and from the long 
absence of rain, at the period fever takes place, are nearly choked. More- 
over. I have been told by the Surveyor of Revenue Works, that many of 
them are not carried out to low-M-ater mark on the line wall. In the state of 
the streets or houses. I am not aware that any cause existed which was not 
present in the same, or in a worse degree in former years." 
On the subject of sporadics, Mr. JDix says — 

" I only saw ten or twelve cases of the late epidemic : but those appeared to 
me to diftbr, in no respect, from bad sporadic cases of Yellow Fever I had 
witnessed here annually from 1820 to 1526." 

J)o you consider the disease epidemic, propagated by the general vitiation of 
the atmosphere of the Rock ? 

" Yes, epidemic : and propagated by general vitiation of the air of the Rock ; 
because any one, not having passed it, was almost sure to take it if they 
ventured to sleep in town. 

" Had ynalaria, or the effluvia from marshy places, any, cvnd what influence in 
the production of this disease ? 

Malaria, I suppose to have given origin to this disease."' 

SuKGEOx M'Leod, 42>-d Regime>-t, dated April 16, 1829. 

Do you consider the disease contagious, i. e. propagated by contact, and 
did the very latest cases appear to have been contagious ? 

I never, in any instance, knew the disease to have been communicated from 
one person to another/' 

AsSISTA>-T-SrEGEO>- BuLTEEE, 94tH REGIMEJfT. 

* ■ Were you ever in the West Indies or Gibraltar, and have you in either place 
or elsewhere witnessed a similar visitation of sickness ? ^ 

Q 



218 



Opinions of Dr. Browne 



" I have never been in^theWest Indies, but at all the different stations on the 
•western coast of Africa, and have witnessed a similar visitation of sickness. 

" Do you consider this disease as originating in Gibraltar, or as an imported 
disease ? State the facts on which your opinion is founded. 

" Having no facts- to elucidate from my own personal knowledge, relative to the 
origin of the disease, and not being able to discover any of its being contagious, 
I am naturally led to conclude that it is of local origin, from the great heat and 
drought, the former being greater than what I have experienced in Africa, and 
the lofty situation of the Rock impeding ventilation when an easterly wind pre- 
vails, [a fog or cloud] covering its summit and approaching to its base, causing 
febrific exhalations, which, on my arrival here, were prevalent and long con- 
tinued : I evidenced the mitigation of the epidemic in November, and the 
visible improvement in the worst cases on the approach of a westerly wind, 
which was only for a short time, when an easterly re-appeared. 

" Do you consider the disease contagious, i. e. propagated hy contact, and did 
the very latest cases appear to have been contagious ? 

* ' I do not consider the disease to be contagious ; out of the number of order- 
lies, who were in constant attendance upon the sick, and necessarily subject to 
the most unpleasant effluvia, only one took the disease and recovered, which I 
attributed to bodily fatigue and watching, together with a recent fit of intoxica- 
tion ; and J on ray arrival, a number of men affected with other diseases who were 
sleeping in the same wards with the fever cases, and attending upon the sick, 
escaped the disease, the former of whom I of course removed into a detached 
ward ; and an orderly of the 94th Regiment, at the Naval Hospital, who it 
has been stated caught the disease, while in attendance on the sick on the 6th 
September last ; from the man's own statement, he had been in No. 24 District, 
in company with a serjeant of the 12th Regiment, who also took the disease ; 
therefore, from these strong examples, I form my opinion. Another very 
strong example is, that the officers used constantly to accompany me around 
the wards to visit the sick of their own companies, and also two of their 
brother officers who were seriously ill with the disease, and were in the habit 
of shaking hands with them 5 I can positively assert that not one of them took 
the disease. 

" Do you consider the disease epidemic, propagated by the general vitiation of 
the atmosphere of the Rock ? 

" I do consider the disease epidemic, from the men most invariably having 
been taken ill when on guard, or after having been in town, where the 
vitiation was much greater ; but I know an instance of one man who was 
serving as cook to the Grenadier Company, who never was out of camp at 
Windmill Hill during the epidemic, but was at the canteen with a number 
of other men, when it was stated that there was a boy ill with the disease in 
the adjoining room. The man himself states, that he did not go near the 
patient ; he, however, was taken ill after a fit of intoxication, being generally 
a man of sober habits. I can also state, from good authority, of a girl having 
been affected with the epidemic at the Signal Tower, who never had any 
communication with the town.*" 

AssisTANT-SunGEOiSr Bkownb, or THE 23bi> RegtmejSit. dated April, 1829. 

" What was the state of the public sewers, and was any marked difference 
observed in the cleanliness or filth of the streets, houses, Sfc. f Report at large 
on this subject. 

^' I was not in the garrison at the commencement of the late epidemic, 
and cannot say. But goes on to state some remarkable proofs from official 
authorities that the sewers were in a bad state. 

" Do you consider this disease as originating in Gibraltar, or as an imported 
disease ? State the facts on which your opirdon is founded. 



* This authority readered quite null from investigations of Dr. Chervin, as 
related in one of his works. 



on Nature and Causes of the Epidemic. 219 

" I consider the late epidemic fever, as originating in Gibraltar, for the following 
reasons; viz., 1st. Because I know of no proof of its importation, and because, 
when it has been imported into other places, even on a large scale, no epidemic 
has been produced in consequence. 2nd. From the non-communication of the 
disease by patients labouring under it, by convalescents from it, or by any 
articles used by the sick, when such patients, convalescents, or fomites, had 
been removed beyond the local source of infection, which in the late epidemic, 
was the case on the Neutral Ground, Windmill Hill, and Europa Flats; no 
person in any of these situations, having contracted the disease, from coming in 
contact with patients, convalescents, or their dirty clothing, &c. I am aware 
that a few individuals, amounting, perhaps, to 15 or 20, sickened in these 
situations, without having been known to enter the garrison ; but, at the same 
time, it is an established fact that fevers of a highly aggravated nature, are 
contracted annually in the first of these localities, which i'urnished at least 
three-fourths of the total number of such cases ; and, while numerous instances 
are to be found, where women, (soldiers' wives) living in camp in these places, 
washed the dirty linen, &c., of fever patients, without injury, is it to be cre- 
dited that a little black vomit on the skirt of a coat caused the disease ? I 
may cite the exposure of the orderlies, and patients in the Naval Hospital for 
other diseases ; in proof of this position, not one of whom contracted the 
epidemic fever, until it had previously appeared among the civilians, in the 
immediate vicinity, who had no intercourse whatever with the sick, and were 
in general extremely anxious to avoid coming near them. 3rd. From the 
disease being epidemic in autumn, or rather during the last six months of the 
yediV only, a season so notorious for the production of fevers from malaria, 
and also from its being like them, checked suddenly by a reduction of tem- 
perature, so inconsiderable as not to influence other diseases reputed conta- 
gious. 4th. From the peculiar severity of the disease as contracted in certain 
localities, showing thereby a difference in the concentration or virulence of the 
cause in these situations, a fact generally observed in the fevers from malaria, 
and so very different from the usual operation of contagion, especially, as these 
places are often far from being either the most crowded and filthy, or even the 
worst ventilated. In proof of what is here asserted, I may mention the highly 
aggravated nature of the cases admitted into the Military Hospital from 
North Flat Bastion, Southport, and Convent Guards, which were furnished 
at an early part of the epidemic, chiefly by the 43rd regiment, and also the 
very great mortality among the men employed in the cultivation of Rouvier's 
and the adjoining garden in the south. 5thly. From Yellow Fever never 
appearing in an epidemic form, in any situation, where sporadic cases of the 
same disease do not occur ; such cases demonstrating the existence of the local 
cause, though its operation may be limited by circumstances, unknown to us, 
influencing the production or propagation of malaria. That sporadic cases of 
Yellow Fever occur in this garrison, nearly every year, is a fact beyond dispute, 
for the difference of duration supposed by some to distinguish them from the 
^epidemic disease, is a natural consequence of a cause less extended and pro- 
bably less active, and after all it is a difference purely supposititious, as very 
many cases in the late visitation were equally protracted. The test of im- 
munity from second attack, is also in favour of the identity of the disease, in 
the great majority of instances. It is said that sporadic cases of variola occurj 
without being followed by an epidemic, and so also may cases of Yellow Fever, 
but I know of no instance of such sporadic eases of variola, appearing annu- 
ally in certain situations, differing only in number in different years ; nor of 
epidemic variola, losing uniformly its contagious quality, when a subject 
labouring under it is removed from a certain locality. 6thly. From the fre- 
quency of relapses in the late epidemic, nearly one-fifth of the cases which 
occurred in the regiment (23rd) having suffered from a second attack, and one or 
two even from a third. This fact is out of all analogy with any known conta- 
gious disease, such as small-pox, measles, scarlet fever, plague, or even typhus, 
the contagion of which last is much more doubtful. 7thly, From the almost 

Q 2 



220 



Opinions of Dr. Broivne 



total disappearance of every other acute disease from the garrison, during the 
prevalence of the late epidemic, an occurrence not to be observed in any epi- 
demic of a contagious nature, such as small-pox, measles, &c. ; these diseases 
prevailing often simultaneously, and without exerting any evident influence on 
the propagation of each other mutually ; a proof that the epidemic Yellow 
Fever, proceeds from a local vitiation of the atmosphere, while the small-pox, 
&c., depend, in a measure, upon a specific contagion for their propagation. 
8thly. From Yellow Fever being confined within certain parallels of latitude, 
and under certain altitudes within these parallels, and also for its attacking 
emigrants from northern climates, or healthy districts, with greater severity 
than the inhabitants of the places where it prevails, or persons acclimates, 
peculiarities in which it coincides most strikingly with the more concentrated 
forms of the fevers of malaria. I need scarcely say, that the British troops in 
Lieria, (Portugal,) in 1827, suffered from remittents in a trifold ratio to the 
inhabitants of that place, and thousands of similar instances may be adduced. 
Othl}'. From Yellow Fever attacking, in some epidemics, three individuals 
in the lower floor of a house or barrack, for one in the upper story. It was 
observed by assistant-surgeons Brown, of the 43rd, and Gillice of the 12th regi- 
ment, that the orderlies and others, who slept in the lower wards of the 
Naval Hospital, during the late epidemic, were generally attacked sooner 
than those who slept in the upper wards, beside the sick. In Bosano's family 
at Rosia, every individual susceptible, eight in number, in the upper story 
escaped the disease ; while every person in Belasco's family, living directly 
under them, w^ho had not already passed the disease, was attacked. lOthly. 
From the failure of all attempts to communicate the disease by inoculation 
with blood, black vomit^ saliva, &c., or b}'^ swallowing these fluids; and from 
the inutility of fumigation, expurgation, and every other " sanitary" measure 
whatever, excepting the removal of the inhabitants from the particular locality, 
in arresting the progress, or diminish ino- the mortality of the disease. 

" In what respects does the late epidemic differ from the bilious remittent fever 
of the same place, at certain seasons of the year? 

" Bilious remittent fever, properly so called, is not a common disease in Gibral- 
tar, and the cases of it occasionally seen in the hospital, are generally to be 
traced to the Neutral Ground ; but the common continued autumnal fever of the 
garrison does not differ in any respect, from the majority of mild cases of the late 
epidemic. In the autumnal continued, instances are not uncommon in which 
death took place from the 2nd to the 7th day, and the cases generally either ter- 
minate in convalescence or in death, or become distinctly remittent or intermit- 
tent from the 7th to the 14th day ; in point of duration, therefore, the diflference 
betw^een the fever of ordinary years and the late epidemic, is much more 
fanciful than real, in as far as my very limited knowledge of the subject enables 
me to judge. The peculiar appearance of the eyes, the nature and seat of the 
headache ; and the want of remissions, are symptoms common to both, though 
more generally present, and better marked in the epidemic disease. The 
appeai'ance of the yellow skin, black vomit, dark and black stools, and 
hemorrhages, are rare in ordinary years, but taking 1826 as an example, nearly 
thirty such cases are said to have occurred in the military and civil hospitals, 
exclusive of those of the ordnance, and 64th regiment, in the last of which 
several cases are said to have been treated. I do not affirm that black vomit 
presented itself in all these cases, but a few of them had that symptom, several 
had dark stools, and all of them vellow skin, while the number of fever 
cases in the returns of the 12th, 43rd, and 94th regiments quartered in the 
South, prove to demonstration, an unusual prevalence of that disease among 
them, as compai-ed with the 42nd, quartered at Windmill Hill, or even with 
the 23rd, quartered in the town. I conceive that this extraordinary prevalence 
of a fever in the south district, the importation of which was never dreamt of, 
and when the symptoms of yellow skin and black vomit were frequent in the 
garrison, beyond proportion as compared with this disease in ordinary years, 
will form, like 1810, one of a series in the progression of fevers originating in 



on Nature and Causes of the Epidemic. 



221 



Gibraltar, of which the yellow malignant pestilential is the last and most 
aggravated. The only difference between the epidemic and the autumnal con- 
tinued fevers of the garrison, are the epidemic prevalence the more frequent 
occurrence of yellowness, hemorrhages, black vomit, and dark or black stools; 
— the far greater proportional mortality ; and the much less tendency of the 
former to terminate in a remittent or intermittent form after the fifth or seventh 
day. The great frequency of pulse, and heat of skin, are symptoms com- 
mon to the autumnal continued, and the epidemic disease, but they are by no 
means peculiar to the latter, as the pulse not unfrequently beats from 45 to 90, 
especially in cases where delirium, or a degree of stupor, set in early in the- 
disease, and the heat of skin is often moderate, and in the fatal cases, generally- 
much reduced for several hours (sometimes 48) before death. The most uni- 
form post mortem appearance, namely, change of colour in the liver, is found 
in both, as, also, the dark coloured spots round the cardia, so frequently sup- 
posed to be gangrene of the stomach. I have avoided contrasting the epidemic 
with bilious remittent, because the last disease is rare in the garrison, but it is 
necessary to observe, that the pale yellow colour of the eye and skin, (said to 
be peculiar to the epidemic,) vibices, haemorrhages, the presence of black 
vomit in the stomach after death, and its ejection during life, have also been 
described in epidemics of a remittent type in Italy, Switzerland, and elsewhero 
in Europe, as also in the East Indies, 
" What are the diagnostic symptoms? 

" In answering the preceding question I have noticed the chief distinctions 
between the epidemic and common continued fevers of Gibraltar ; and I need 
scarcely observe, that the supposition of the sporadic cases which appear annually 
in the garrison, laeing either cases of hepatitis or icterus, is not within the scope 
of credibility. 

"Z>o you consider the disease contagious, i. q., propagated by contact, and did 
the very latest cases appear to have been contagious f 

I know of no evidence of the disease having been propagated by contact; 
as the child sleeping in the same bed with the father or mother labouring 
under the epidemic often escaped it, and some individuals who had attended all 
the other members of a large family were equally fortunate. It was rarely that 
two soldiers in the 23rd Regiment were admitted from the same tent within 
a month, and an example is scarce to be found where this happened within a 
week, and in no instance, without the second person attacked having mounted a 
guard in the interim. Married men often passed the first night after their 
attacks in the same tent with their wives and families ; and I know of no 
instance among the military where any bad effects followed this want of precau- 
tion. In short, no evident relation could be traced between the first introduc- 
tion of sickness into a house and its after progress through the family, some 
weeks, and even two months, intervening in many instances between the first 
and second cases in the same house, so long as the disease was not general 
around ; but as soon as it became frequent in the vicinity, all the other members- 
of the family, hitherto healthy, often sickened in a few days. The instances 
are very numerous, on the contrary, where the individuals of a family sickened 
in rapid succession within the sphere of epidemic influence ; but this is more 
peculiarly a consequence of a general vitiation of the atmosphere than of a 
contagious quality in a disease, and proves little for either side of the question. 
The very latest cases did not seem to vary from the rest by seeming to possess 
any contagious property. 

" Do you consider the disease infectious, i. e., propagated by the infected at^ 
mosphere of a sick room? 

" It may be stated as a fact, ttiat the atmosphere of a sick room does not com- 
municate the disease with greater facility than the general atmosphere of the 
districts where the epidemic prevails ; and, out of these districts, the disease is 
no longer epidemic, nor is it anywhere transmissible. This inference, in my 
opinion, is warranted from the persons who went to St. Roque and elsewhere, 
and sickened there, not having affected the health of their immediate attendants ; 



222 



Opinions of Dr. Browne {continued). 



from those who sickened in the military and civil encampments, having, in no 
instance, propagated the disease ; and from the orderlies in the Naval Hospital 
having remained unaffected until the inhabitants of the adjoining houses vrere 
already attacked w^ith the epidemic. It is necessary to remark, that the attacks 
of the orderlies in the Ordnance Hospital, and of a nurse in the Civil Hospital, 
are said to be exceptions to what is here stated ; but the facts with regard to 
the former, in so far as I know, are defective in many points absolutely essential 
to determine the question ; and the nurse was in the habit of visiting her hus- 
band, a soldier of the 23rd Regiment, when he was on duty in the town, and 
was with him at South Port guard a short time before her attack ; she also 
frequented a lodging-house in the lower part of 24 District, occupied by a 
Serjeant's wife of the 12th Regiment. 

" Do yon consider the disease epidemic, propagated hy the general vitiation of 
the atmosphere of the Rock f 

" I consider the disease to be produced by a vitiation of the atmosphere of 
the Rock, and that this malaria is more or less active in proportion to the distance 
from its source or to its accumulation and concentration in particular situations. 

" Had malaria, or the effiuviafrom marshy places, any and what influence in 
the production of this disease ? 

" There is no marsh, properly so called, within the territory of Gibraltar, nor 
even within a considerable distance of it ; besides, the currents of air passing 
over the marshes of the adjoining country can seldom reach the garrison, as 
they must previously pass the Neutral Ground, where the wind blows for seven 
days out of eight from east to west, or vica versa, so as to interrupt the progress 
or change the direction of the breezes, carrying with them marsh effluvia. 

" Were critical days observed in the course of this fever ? 

"The fifth day was more frequently fatal than any other, and the average 
duration of the disease was about seven days. 

" What were the sequelce of this disease, visceral obstructions, ague, ^c. ? 

" In several cases in the 23rd Regiment an obscure remittent form of fever su- 
pervened the epidemic attack, but its paroxysms did not always begin with 
chills, nor did they uniformly terminate in sweating, and it was as irregular in 
its accessions as in any other part of its course. I have seen jaundice in one 
case, hepatitis in two, and, in a few^, dysenteric affections of more or less 
severity, follow the epidemic disease ; and, in one subject, it appeared to 
develope phthisis, which proved most rapidly fatal ; one or two cases, admitted 
towards the end of the epidemic, became distinctly remittent from an early 
period. 

" Were other acute diseases observable during the epidemic, particularly inter- 
mittent fever ? 

" Every other acute 'disease had almost disappeared ; and intermittents and 
remittents, which were comparatively frequent in the corps since its return from 
Portugal up to the commencement of the epidemic, also ophthalmia, were no 
longer to be met with. 

(■ i j^Qj^Q persons who had suffered once, or had had the Yellow Fever of the 
West Indies, liable to a second attack ? state number of each. 

" 1 believe the immunity from second attack is very great ; but, at the same 
time, I do not consider it so absolute as common report may seem to warrant. 
The only soldier in the regiment who asserted that he had passed the disease 
during an epidemic period in Barbados, and who had served eight years in the 
West Indies in another corps, died of an attack of the late epidemic. It would 
seem from the table in the Appendix* that a severe attack of remittent gives a 
comparative immunity against Yellow Fever, but it is on so very limited a scale 
as, of itself, to warrant no conclusion. However, as few individuals who have 



Note from Dr. Browne's Table in the Appendix to his Report. 
Proportion of fever cases to general strength, 142 in 530, or 1 in 3ff. 
Proportion of epidemic cases after intermittent, 25 in 93, or 1 in 
Proportion of epidemic cases after remittent, 11 in Gl, or 1 in Sfj. 



Statement of CataUna Fenic. 



223 



resided any length of time in a warm climate liave not suffered from remittent, 
and as such long residents enjoy an immunity independently of any previous 
attack of Yellow Fever, it may be a question yet to be determined how far 
residence simply, or how far having suffered from remittent, may contribute 
to this exemption. 

" What is the state of health in the adjacent parts of Spain and Barhary? 

" I do not know that any epidemic disease prevailed in the adjacent parts of 
Spain or Barbary ; but it was asserted, in November last, that some cases of 
fever of an aggravated form had appeared in Algeciras, and, it has since been 
said, that they were smugglers who communicated with the garrison. The 
latter statement is important, if true, as proving the non-contagious nature of 
the disease ; while the former would be equally a proof of the influence of 
physical causes and of local origin." 



Letter (H.) 
Catalina Fenic' s Statement. 

Gibraltar, November 14, 1829. 
" Catalina Fenic, widow of Felix Fenic (alias Mateo) has this day made a 
statement, in presence of the undersigned, to the following effect, 
and which, if required, she states her readiness to corroborate, on 
oath, before competent authority : — 
Declares herself to be the widow of Felix Fenic, who died in the autumn of 
last year : says that her husband was about 68 years of age, and of a broken 
constitution ; that he had resided in Gibraltar about 33 or 34 years. 

" States that, in 1804, she was the wife of a man named Salvador de Ortega, 
who was then the intimate friend of Felix Fenic, the person above alluded to, 
and to whom she was married in 1805, after the death of her first husband 
(Salvador de Ortega), who died of the epidemic fever in 1804. 

States, and is ready to make oath, that her second husband (Felix Fenic) had, 
in 1804, a severe attack of the epidemic fever of that year, and that she and 
her first husband (Ortega) visited him frequently ; that, in fact, she herself 
attended him jointly with another woman, since dead ; that, during his illness, 
his residence was in a small house at the bottom of the stairs, in front of the 
Civil Hospital, then called the Blue Barracks ; that, during the epidemics of 
1813 and 1814 her husband resided in Gibraltar without experiencing any 
indisposition from the fever of those years. 

" States that, after the death of their two children (Salvador and Catalina 
Fenic), mentioned in the proceedings of the Board of Commissioners to have 
taken place about the middle of August, 1828, her husband became greatly dis- 
tressed in mind ; that, on a certain Thursday, the police came to their house to 
warn them, in common with others of the district, to remove into camp ; that, on 
that day, her husband particularly complained of a large rupture which he had 
had for many years, and which occasionally troubled him, being worse than 
usual, and increased in bulk ; that she had her husband brought to the Civil 
Hospital next day, when he was seen by Mr. Fraser and others, but not being 
a fever case he was sent back to his house : on the evening of the next day 
they were, like all others in her district, sent to camp on the Neutral Ground. 

" In camp her husband was seen by Dr. Hennen and others, but was not 
ordered to the lazaretto, to w^hich all fever patients were sent: he died in their 
tent on Monday morning ; the tent was not ordered to be fumigated or washed 
by any one, and that she took no precaution to prevent contagion, as she was 
sure her husband did not die of the fever : declares that there was no vomiting, 
no yellowness of skin, or other usual signs of a bad fever. Says, that he com- 
plained greatly of a pain in his throat, and that it was a question among thft 
medical men who saw him as to bleeding him. but that they said they had no 
lancets v.ith them. 



224 



Opinions of Palloni on the 



"With reference to her husband having gone on board any ship in the bay at 
any time last summer, she most positively asserts that it vras not so, as he never 
went out anywhere (he being an old infirm man) without letting her know ; is 
sure he had not been in a boat for 10 years past. 

" She is equally certain that her two children, Salvador and Catalina Fenic, 
were not on board any boat or ship, as stated in the proceedings of the Board 
of Commissioners, as they were always under their eye, and were not running 
about like other children, or ever in the habit of going on the water. 

" States that, with respect to the boy Francisco Calfiero, neither she herself, 
nor any of her family, knew anything about him ; and that what he stated to 
the Commissioners as to her boy Salvador (13 years of age) and Catalina (11 
years of age) having gone on board of ship is a made-up falsehood. 

" States, that her children had not any of the symptoms of the epidemic of 
Gibraltar, with which she had been familiar dm'ing her long residence ; that 
the doctor (Lopez) observed some indigested portions of figs in what they 
passed by stool ; that they had no vomiting ; that their appearance after death 
was not changed like that of those persons whom she has seen die of the Yellow 
Fever, and that she cannot make herself believe that they died of that disease. 

" Says that, dmung the illness of her children, five of their playmates (the 
children of her gossip Juaquina) constantly came to see them, but that none of 
these children w^ere taken ill ; that the whole of these children, however, passed 
the epidemic afterwards, when permission was given to some of the families to 
return to the expurgated habitations. 

(Signed) Hugh Fkaser, Surgeon of the Civil Hospital. 

A. Beow>'e, M.D., Assistant Surgeon 23rd JR. W.F. 
J. GiLLKKEST, M.D., Surgeon 4Brd JRegiment." 



" I, the undersigned, do hereby certify that, on this 13th day of May, 1829, 
Catalina Fenic, in the foregoing statement named, appeai'ed before me, and 
I then interpreted to her the whole of the said statement, which she confirmed 
in every particular in the fullest and most positive terms, and added that her 
late husband, for several years previous to his death, left off going at all into 
the bay, and that, being an old and infirm man, he gained his livelihood by 
purchasing tobacco and making it into cigars. 

(Signed) Alexaxder Shea, Notary Public , Gibraltar.'''' 



Letter (I.) 

Of the Yellow Fever outbreak at Leghorn in 1804, which has been usually 
termed an epidemic, though confined to a few streets, an account was given 
by Dr. Palloni immediately on the cessation of the disease. 

He concludes as follows : — 

" I shall terminate this short essay with two brief observations. The first 
is, that if, on the one hand, the description which we have exactly given of 
the malady prevailing in this city, shows the greatest analogy with the typhus 
icterodes of Sauvages and Cullen, and consequently with 'the West Indian 
fever, it is, on the other hand, proper to confess, that either from local cir- 
cumstances, or from difference of climate, or from a less diftusibility of the 
morbific atmosphere, its effects and propagation have been with us infinitely 
more mild and more limited than in any other part where an analogous disease 
has developed itself. 

" The other observation, which may serve as an explanation to the pre- 
ceding is, that the infection of this fever is of such a nature that the pure and 
renewed air decomposes the morbific agency at a small distance from the sick 



Yellow Fever at Leghorn in 1804. 



225 



person ; on the contrary, an air stagnant and full of animal exhalations becomes 
easily a vehicle for it. This is why it has more particularly manifested itself in 
the dirty and badly-ventilated streets of the city, and especially in the houses of 
the poor, among whom, besides the individual disposition necessary to the 
action of every contagion, the smallness of the chambers, the want of cleanli- 
ness, and the crowding of the inhabitants multiply the points of contact and 
facilitate infection. On the contrary, in clean and spacious streets, and in 
commodious and well- ventilated houses, the disease has either rarely mani- 
fested itself or been easily checked. Thus, we can confirm the remark of 
Currie, that even in hospitals well-situated and clean, the morbific infection 
has been confined to the individual attacked, without spreading to those suf- 
fei'ing from diseases of a different kind, in this respect differing from other 
epidemic and contagious diseases. And, finally, for the same reason, the 
fever of which we are speaking, has for the most part raged in maritime cities 
without extending to the interior of the country ; and in those who left the 
districts where it prevailed unless they were ah'eady ill when they set out, 
no germ of the infection has developed itself, the infection seeming thus to 
have been corrected and destroyed by change of air and situation. In fact, if 
we except two or three streets of Leghorn, which the malady seemed as it 
were to have chosen for its abode, few other parts of the city were attacked 
by it, and, with some exceptions, it did not extend to the smallest distance 
from the city, so that numerous persons went, and much merchandize was con- 
veyed, daily from the most infected districts to the surrounding country. 

" A healthy man, if brought into contact with those suffering from the 
disease, never communicated the infection to others, unless himself attacked 
by it. And, in fact, though greater precautionary measures were taken 
regarding those w"ho were really attacked by the malady, and regarding the 
clothes and other things which immediately belonged to them, yet we have 
not perceived that the other healthy individuals of the same family, or the 
other furniture of the same house, ever became a vehicle of infection. Money, 
merchandize, and other matters were in continual circulation both within and 
without the city, yet the infection was not diffused thereby. I have besides 
observed that a certain habit gradually acquired of receiving the impressions 
of this miasma, easily took away its power of acting ; in fact of the many 
priests that daily visited those suffering from the disease one alone was 
attacked and died from it ; and no assistant in the hospitals experienced its 
effects, and only two or three of the other people so long near the sick took 
the disease. 

" If, therefore, in order to take this infection, there is needed (besides a 
natural disposition) the vicinity or the contact of some one suffering there- 
from, or of the clothes used by him during his malady, and the circumstance 
of an air confined, stagnant, and full of animal exhalations ; — if a small amount 
of habit is sufficient to elude its force ; — if healthy persons brought Into the 
proximity of the diseased, and the merchandize exposed to the free air never 
carried the infection to a distance from the city ; — if, finally, pure air, and 
ventilation destroy this morbific agency in the vicinity of its centre, or of the 
diseased person ; — who does not see the difference between the malady pre- 
vailing at Leghorn and all other pestilential contagions ? How much less its 
force and its diffusibility ! And how false the ideas, how ill-founded the 
fears conceived respecting it in districts not very far removed from this city ! 
But we cannot adduce any stronger or more convincing argument of the 
utility of pure fresh ventilated air than that furnished by the happy results 
obtained in the new temporary hospital of St. James. Situated at no great 
distance from the sea, but far from the insalubrious exhalations of the city, 
and thus obtaining a free ventilation of the purest air, of which its construc- 
tion and the disposition of its parts enabled it to enjoy all the advantages, it is 
truly worthy of remark that scarcely was this hospital opened for the reception 
of patients, when not only the virulence and extension of the disease in the 
city commenced to decline, but many escaped from death who seemed pre- 



2m 



Remarks of Dr. John Davy 



viously about to become its victims. It is wonderful to see how those suf- 
fering from the malady are scarcely taken from their houses, languid, 
prostrated, and as it were conquered by disease, and placed in this new 
asylum, when the vital principle seems in a moment to recover its power : 
they revive ; they confess that a sensation of comfort succeeds to that of 
languor and anguish ; and the malady, assuming a milder appearance, ceases to 
resist medical art, and yields to the suitable curative method already deter- 
mined ; and very soon the patients pass into a state of convalescence which is 
neither long nor painful." 



Letter (K.) 

Extract from " Some Account of the Fever which prevailed in the Garrison of 
St. Ann, Barbados, in 1847, i848, and 1849, by Dr. John Davy, Inspector- 
General of Hospitals.'' Edin. Med. and Surg. Journal, October 1849, 
page 277. 

(The 66th, 72nd, 88th, and Artillery were the regiments which suffered, and 
out of a force of 1,200 men, 196 deaths occurred.) 

P. 281. — " Relative to the origin of the endemic, it must, I believe, be 
confessed that there was the greatest obscurity. The weather at its com- 
mencement was unusually cool and pleasant ; before its outbreak, and while it 
lasted, the seasons were nowise peculiar. Several circumstances at the time 
were pointed out as probable causes, such as an accumulation of rank vegetation 
on, with urinous exhalations from, a neglected hollow between the artillery 
and stone barrack, and to windward of the latter ; the state of the Savannah, 
and of the adjoining ground, defectively drained, liable to be flooded after 
heavy rains, to retain water stagnant for a while, and, after a period of drought, 
to become parched and fissured ; the state of the grave-yard, lying between 
the barracks and the shore, in unsuitable ground, either too rocky generally, 
or sandy and unduly crowded ; and, lastl}^, the breaking up of a considerable 
extent of ground to some depth, and the levelling it for the improvement of 
the works in the neighbourhood of the barracks, where the disease first 
appeared. Whether any one of these circumstances, or whether all of them 
combined, had etiect or not in the production of the disease, I cannot ventm-e 
to affirm. That it was of local origin seems to me hardly doubtful, v/hatever 
the local cause may have been. The fact most conclusive in proof of this was 
the isolation of the disease. During the whole period it was confined to the 
garrison of St. Ann, and, during a considerable portion of the period, to the 
barracks and quarters situated on the lower ground, where the drainage was 
most defective, and the conjectured local causes most active. 

" An opinion, I am informed, has been expressed that the disease was im- 
ported, and by Her Majesty's war-steamer ' Growler,' from the coast of 
Africa. That ship was employed in conveying liberated Africans to the West 
Indies. She left Sierra Leone on the 12th of November, 1847, and arrived at 
Trinidad on the 5th of December. During the voyage, 46 deaths occurred 
amongst the emigrants from chronic dysenter}'-, and two deaths amongst the 
crew from fever. The emigrants were landed at Port of Spain. No fever 
was there introduced, although no precautions were taken that I have been 
able to learn to prevent unrestricted communication. She took her departure 
from Trinidad on the 8th of December ; arrived at Barbados on the 10th ; 
proceeded from thence on the 18th, and reached the Bermudas on the 24th. 
There, according to established usage, having come from the coast of Africa 
with fever on board, she was placed in quarantine ; the crew landed and kept 
apart — the sick from the well, and the vessel thoroughly cleaned and fumi- 
gated. On examining the holds and bilges, they were found in a very offensive 
state, from accumulated vegetable matter, rice, chips, and shavings, in a 
decomposing state. ' The atmosphere in the carpenter's store-room would not 
support combustion.' The fever was not communicated at the Bermudas to a 



on the Epidemic at Barbados in 1848. 



227 



family of five persons associated with the sick on shore ; but two individuals 
from the shore, who were engaged on board in conducting the cleaning of the 
vessel, contracted it, as did also a certain number of the crew similarly 
employed, and only those so employed. The total number of cases of fever 
under treatment from the ' Growler' were 75, of which 3 only terminated in 
death, 72 having recovered. These particulars I have collected from an 
' Extract from the Journal of Mr. Robert M'Crae, Surgeon of Her Majesty's 
ship " Growler,"' a copy of which interesting document is now before me, 
with which I have been favoured by the head of the medical department 
of the navy, Sir William Burnett. Mr. M'Crae, who had the best oppor- 
tunities for an'iving at the truth, in his journal expresses himself satisfied that 
the fever originated in the ship from the causes referred to, and that it was 
nowise contagious. The facts he adduces seem to bear him out fairly in these 
conclusions.* 

" But even if these conclusions of his be doubted, there is no proof that the 
Yellow Fever in Barbados was derived from the ' Growler.' It was rumoured 
that the two men of the 88th Regiment who were first attacked, and who died, 
had been on board. The result of careful inquiry is that this rumour was 
groundless — a mere conjecture. Even considering the time of arrival of the 
* Growler' at Barbados, on the 10th December, at noon, and that the first 
two fatal cases in the 88th terminated on the 19th of that month, one after a 
treatment of three days in hospital, the other of five days, it seems improbable 
that the fever was contracted by a visit to the ship, were there proof, which 
was altogether wanting, that such a visit had been made. Moreover, the wives 
of the two men first attacked also experienced the disease, and according to my 
recollection, for I cannot find any note on the subject, as soon as, or a little 
before, their husbands ; and they too fell victims to it. They occupied a low, 
ill-ventilated room of the iron barracks, intended, not for the accommodation of 
troops, but for use as a store-room. It was here that the disease first appeared, 
and scarcely a person escaped the fever who, from inconsiderate indulgence, 
had been permitted to be there. They were married men and their families, 
to whom any place apart is always acceptable. Further, it is worthy of remark 
that the inhabitants of Bridgetown, like the inhabitants of Port of Spain, in 
Trinidad, were not visited by fever after the arrival of the ' Growler,' many of 
whom, in communication with the crew in affording supplies, must, it may be 
inferred, have been more likely to have contracted it, had the disease been 
contagious, than the troops in garrison. Even the character of the fever 
amongst the crew of the ' Growler,' and of that in the 88th, had not such a 
close resemblance as to warrant their being considered identical in species. 
Yellowness of the skin is not mentioned as having appeared in any instance 
amongst the former. The majority of the ship cases appear to have been of 
no great severity, and without the symptoms denoting the malignant character, 
a mildness well marked by the large proportion of recoveries, 1 only in 25 
proving fatal, whilst in the garrison 1 died in about every 5 attacked. It is 
true that in some of the ' Growler' cases there was irritability of stomach, and 
that, in one which terminated fatally, death was preceded by ' black vomit,' a 
solitary example, as reported by the surgeon. But irritability of stomach is 
not an unfrequent accompaniment of the common remittent fever of the West 
Indies, and ' black vomit' is occasionally witnessed in it, or in sporadic •cases 
of fever, which may be of the nature of Yellow Fever, although solitary. The 
symptoms of the two, viz., of Yellow Fever and of remittent, excepting when 
the diseases are strongly marked, having many points in common, and conse- 
quently difficult to be distinguished. 

* " When the holds of the * Growler ' were opened at Woolwich, after her return 
from the coast of Africa, two men who slept directly over the hatchway were seized 
with fever, possessing all the characteristics of Yellow Fever, and in the course of a 
few days they both had black vomit and died in the Marine Infirmary, where they 
had been taken at the commencement of the disease." Bryson on Climate and 
Diseases of African Station, p. 224. 



228 



Yellow Fever at Barbados in 1848. 



" The same persons who suppose that the fever was imported, of course also 
suppose that it was contagious or infectious. Whether Yellow Fever is con- 
tagious or not seems to be admitted to be a difficult problem. The manner in 
which those who have specially considered the subject are divided in opinion 
respecting it, is sufficient proof of this difficulty. I feel it right candidly to 
confess that at the outbreak of the disease I belonged to the class of non- 
con tagionists, and that what I witnessed during its progress confirmed me in 
the persuasion. The fact of its being confined for so many months to the low 
localities in which it first appeared ; not spreading to the troops occupying the 
higher barracks, though not more than 1,600 feet distant; and not spreading 
to them in the instance of the 7tli Fusileers, when the 88th were encamped 
within a few feet of the upper barracks, and for some time were sending into 
hospital fresh cases of the disease ; the manner in which the inhabitants of the 
populous and crowded town adjoining, Bridgetown, in unrestricted communi- 
cation with the garrison, remained exempt from it ; the small number of cases 
of the disease which originated in the hospital, whether amongst the orderlies 
attending on the sick, or amongst the sick themselves — such who were 
admitted with other ailments — are circumstances, it seems to me, not recon- 
cilable with the idea of the fever being of a contagious character. I have 
alluded to the small number of cases of fever that originated in the hospital. 
From a return now before me it appears that from the 26th February to the 
30th September, 1848, in the 66th hospital, one orderly only attending the 
sick was attacked with fever, and that slightly, and only three patients admitted 
with other diseases. 

" Some respectable medical authorities hold a doctrine, as it were, inter- 
mediate between that of contagion and of non-contagion, viz., that a disease 
not originally contagious may become so under peculiar circumstances. To 
prove or disprove this is necessarily difficult. It must be kept in mind that 
every endemic or epidemic disease has, as to the manner of its occurrence, 
after its first appearance, a good deal of the character of an infectious or con- 
tagious disease. Every disease of the former kind has, at some time or other, 
been held to belong to the latter. Those who advocate this expediency doc- 
trine might adduce in support of it the circumstance that, though the 7th 
Royal Fusileers, in communication with the 88th, escaped the fever, and 
though the 72nd Highlanders, lor some months similarly situated, also escaped 
it, yet ultimately the disease appeared amongst them, and after its first appear- 
ance spread rapidly. In reply, it may be remarked that, considering how near 
the regiments were stationed in the same garrison, living in the same manner, 
performing the same duties, and often in common, and exposed, therefore, 
partially to the same causes, it is more surprising that the 72nd so long 
remained exempt, than that it was at length attacked. 

The history of Yellow Fever in the West Indies, from the early period 
when, by the contagionists of that time, it was called the ' Mai de Siam,' to 
the later period when it was named the ' Boulam Fever,' seems to me to afford 
corroborative evidence that in every instance it has been of local origin, and 
neither contagious at its commencement nor in its progress. From all the 
information I have been able to collect, Yellow Fever is not the prevailing 
fever of the western coast of Africa ; it is doubtful whether it ever occurs 
there. Of this we are certain, that it rarely in the West Indies attacks indi- 
viduals of the African race. We are also certain that those situations most 
exposed to infection or contagion from without, such as ports communicating 
most freely with other ports and marts of commerce, are not more frequently 
visited by Yellow Fever than spots where there are troops in a manner isolated. 
I think, too, it must be admitted that in no instance — not a single one — not 
even in that specially called the Boulam fiever — has there been fair and satis- 
factory proof afforded that the disease was imported, and not of local origin." 



Extract from Writings of Dr. Fergusson. 229 



Letter (L.) 

Sojne Remarks on Yellow Fever from the pen of the late Dr. W. Fergusson, 
Inspector- General of Hospitals. 

" In regard to the contagion of Yellow Fever, all those best qualified to judge, 
that is to say, those who have spent their lives and devoted their services in 
the countries between the tropics, where it is so often present, are of the same 
opinion. I do not pretend to say that, amidst the heterogenous mixture of 
which our profession is composed, I have not heard some profess, and even 
subscribe, to a different belief; but I can declare that, I never knew a single 
instance of any one, provided he had had experience of the disease, acting as 
if he believed in its being contagious, or taking any of the precautions which 
the instinct of fear, or the smallest degree of common prudence, would, in that 
case, have dictated : he was contented with voting himself contagion-proof, 
and never scrupled to inhale the breath, or repose w^ithin the atmosphere, of 
the dying patient. * * * I presume it will not be denied that those who 
served during the war in Saint Domingo, where so many British troops perished, 
must have had some experience of Yellow Fever. I remained there till the 
last, and saw the work of destruction completed. At first, every new comer, 
whether medical or otherwise, had his fears, or, I should rather say, had the 
firmest belief in contagion ; but with none did that prejudice ever remain 
beyond the year: it vanished infallibly, as soon as he sav/ and had had expe- 
rience of the disease ; and I can declare that, during the latter years of our 
sojourn there, with hundreds of cases daily before our eyes, mixed in every 
conceivable way with the surgical, the convalescent, and the healthy, I never 
even heard the idea started, nor do I recollect a single precaution, advice, or 
observation, that acknowledged the existence of contagion ever being directed 
to the medical staff of the army from any quarter. I appeal to the writings 
of Dr. McLean, the evidence of Mr. Weir, Dr. Jackson, Drs. Theodore 
Gordon, Borland, Inspector Warren, and all the medical officers who served 
there to bear me out in this assertion. I appeal to the evidence of every 
medical officer now serving in the West Indies, that has ever had experience 
of the disease (for there may very probably be found contagionists among 
those who never saw it), to say whether, in their lives, they ever met with a 
case of Yellow Fever that could, with greater feasibility, be traced to a per- 
sonal communication with a subject labouring under the disease than to the 
ordinary natural causes from which it has been proved to originate. * * « 
It would have done the same to the writers on the fevers of Spain if they had 
not dismissed all their doubts, and set inquiry to rest, by attributing the whole 
to imported contagion. But had they inquired instead of peremptorily deciding, 
they might have found that, during the epidemic visitation of these fevers, not 
only do towns and districts escape altogether, as we see at present in the West 
Indies, but that different parts of the same town are differently affected; and 
so limited often is their influence, that one story of a house and one section of a 
ship will be strongly affected by it, while all other parts of the same tenements 
remain healthy ; and then their wonder at what has been called the desultory 
progress of the fever during the short course of an European autumn need not 
have been so great as to have been inexplicable through any source but that to 
which they referred it. At Barbados, our hospitals, of late, had been in a 
regular course of importation of the Yellow Fever from the navy ; but not even 
inoculation has been able to produce the disease upon any member of the 
hospital corps, by whom I may truly say that the sick had been received with 
open arms, for the antisocial doctrines of ideal contagions are not preached 
amongst us here to the prejudice of duty and humanity. * * * -phg 
physician, in civil life, however superior he may be in learning and talents, as 
he sees only iu'sulated cases, cannot have the same advantages, and must be 
much more liable to form erroneous conclusions. He may see, for instance, 
during the autumnal season of Europe, the inhabitants of a humid, unwholesome 



230 Leitei' of Mr. Melvin on the West Indies. 



house fall ill with dysentery one after the other, according to the degree of 
predisposition or stamina of resistance in the respective individuals, and thence 
conclude, with much apparent justice, that dysentery is a contagious disease ; 
but take him to the well-regulated encampment, and show him its hospitals, 
what every experienced medical man has seen, — a thousand dysenteric patients 
attended by a hundred servants without affecting one of the attendants, he 
certainly would for ever be cured of the delusion.* * * Unfortunately 
these opportunities of observation are not always sought for ; and as experience 
of Yellow Fever in civil life is often trifling, limited to particular seasons and 
circumstances of exposure in the subject, he may, though diflacult to experience, 
believe in his doctrine of contagion to the end, and do his utmost to alarm the 
public : but the military medical officer who has once seen the disease in the 
gross, as it affects newly-arrived troops here, never can be deceived in respect 
to its non-contagious character (if his mind be capable of distinguishing truth 
from error), and, in fact, never is in these climates." 



Letter (M.) 

Among the medical officers of experience in the West Indies from whom I 
have requested an opinion in reference to the contagion or non-contagion of 
Yellow Fever, is Staff-Surgeon Melvin^ wlio served, I believe, no less than 20 
years on thai station. 

In a letter written to a friend, Mr. Melvin says : — 

" My dear Doctor, 

" In my last letter,''very likely I did not express myself so clearly as 
I should have done about the Yellow Fever which occurred when I was last in 
Demerara, 

" During the time I was serving there last I met with two severe visitations 
of it among the white troops in the garrison. During each occurrence of it 
most of the orderlies and men who came into hospital with other trifling com- 
plaints were attacked with it, and many of them died. 

" I put a stop to it the first time this scourge of the West Indies made its 
appearance. I had the most of the white troops removed from the colony. 

" When it made its appearance a second time, in a fresh corps, in 1842, 
the cases of true Yellow Fever were numerous and of the worst description 
— and during this visitation every non-commissioned officer who was employed 
about the hospital was attacked with the disease, as also the orderlies, (two 
of the former and three of the latter died) — I never had the most distant 
idea that contagion was the cause of these attacks among the hospital servants, 
nor with some of the patients who were attacked with Yellow Fever when in 
hospital under treatment for slight complaints; but that the cause was external, 
and from the very insalubrious situation of the hospital. 

" To the windward of this hospital there was a large tract of ground which 
had been recently reclaimed by deposits from the sea. This ground was 
covered by the tides, and when they were out exposed to the hot burning 
sun, which could not do otherwise than produce plenty of exhalations from 
the muddy surface; and, besides this, on all sides, and very close to the hos- 
pital, there were filthy trenches, and the ground for some way all round the 
hospital was very badly drained, in hot weather cracking into large deep 
fissures, which during the rainy season were filled with water. I may state 
that the newly- formed ground was only a few yards distant from the hospital, 
and when in this country before, I have seen vessels of considerable size sailing 
over it. 

" Thinking as I did about the origin and cause of this fever attacking the 
hospital servants and patients under treatment in it, I determined to try the 
experiment of removing the whole of the sick of the white troops from 
the regular hospital to a building in Kingston, nearly half a mile distant, and 



Letter of Dr. Spence on the Disease at Barbados. 231 



which in former days was the hospital. I therefore removed all the sick. 
Some of the cases of Yellow Fever were very bad ; one of them at the time 
was bringing- up large quantities of black vomit, and had much hoemorrhage 
from the gums and nose, with an exceedingly cadaverous and disagreeable 
smell emanating from his body ; in fact, he in evei-y way appeared to be quite 
hopeless. However, to my delight, this case, as well as every other, perfectly 
recovered, which most assuredly would not have been the case had not the 
change of situation been made. And to my further delight and comfort I had 
not a single servant attacked with Yellow Fever, nor did I lose a single case 
from it while I occupied this old hospital ; but I had cases of regular Yellow 
Fever among some of the families in the barracks. During the period I have 
been speaking of I attended the sick of the white troops entirely myself. 

" With regard to the ground about this old hospital which I had the sick 
taken to, it was well drained, and, above all, it was out of the influence of the 
new marshy and muddy ground so very close to the new regular hospital. 

" I cannot think how any one can be a contagionist as regards Yellow 
Fever." 



CopT/ of a Letter from Staff-Surgeon Dr. Spence,* formerly Assistant Sur- 
geon to the hind Regiment, while serving in Barbados in 1838-9, dated 
Sishop' Wearmouth, l^th November, 1846. 

My dear Sir, 

" KNowijiTG your desire for information relative to the cause of ' fever,' 
I have great pleasure in communicating to you a few observations upon an 
epidemic form of Yellow Fever as it affected the 52nd Light Infantry at Bar- 
bados in the latter part of the years 1838 and 1839. 

" You are aware that the 52nd embarked at Gibraltar in Her Majesty's ship 
* Hercules,' commanded by Captain Toup Nicholas, about the 13th October, 
1838, in the most perfect state of health, and also that fever was not more than 
commonly prevalent at that time in the garrison ; but on the day previous to 
embarkation the troops were exposed to a deluge of rain whilst at field exercise 
for the inspection of His Royal Highness Prince George of Cambridge, in 
consequence of which one man was subjected to an attack of gastro-enteritic 
fever, of which he died ; but I pledge you my honour without one symptom 
of Yellow Fever, as I afterwards observed it. I cannot at this time get at my 
notes, and therefore am unable to state with precision how many days this 
death occurred before our arrival at Barbados, but think it must have been 
from 10 to 14 ; however, be that as it may, the regiment disembarked on the 
6th November, without a medical case. 

" On the day of arrival we occupied barracks together with the 36th Regi- 
ment, who the next day embarked in the ' Hercules.' 'Major Cross (having 
resided in the officers' quarters, afterwards tenanted by Mr. Winterbottom,) 
actually going on board with fever upon him, died in three days with ' black 
vomit,' whilst the vessel was in harbour, and his corpse was brought on shore 
for interment. 

On the 10th November, Lieutenant Gough, of the 52nd, first complained 
of indisposition, of wMch he died in three days ; and between this period and 
the 31st December, out of 36 individuals, namely, officers, their servants, non- 
commissioned officers, and soldiers connected with the orderly-room and 
quartermaster's store, all of whom were occupied or residing in the building 
appropriated as quarters, and mess-room for the officers (out of which Major 
Cross had gone), 28 were attacked with fever, and 10 died, whilst of the 
whole regiment residing in the soldiers' barrack, so short a distance as 50 paces 
from the fatal spot, only 30 cases occurred, and none died. 

" An investigation was instituted at the time relative to the cause of this 

* One of the members of the Medical Board lately assembled in London to in- 
vestigate the subject of Yellow Fever, — (See Appendix IV., p. 318). 



232 



Letter of Dr. Spence {continued). 



fever, particularly having reference to the concentration of the pestilential 
essence in the officers' quarters, but after the greatest care nothing could be. 
detected in the slightest degree calculated to throv^^ light on the subject ; but 
it was recommended that the quarters should be evacuated forthwith, and 
forthwith the fever stopped, for after this measure not one case occurred. 
Captain Vigors was in the height of fever at the time of the move, and w^as 
conveyed to a room in the house temporarily hired as a mess-house and quarters 
for officers, and although four officers, who arrived from England in the latter 
part of December, had free intercourse with him, and were constantly in the 
new mess-house, they were not attacked, because they scrupulously avoided 
the infected locality. 

" Thus far, the cause of the malady was involved in the utmost obscurity, 
but at the time of writing this letter I entertain the fullest conviction that the 
' malaria' occasioning such destruction was engendered either in the fresh- 
water swamp, occasioned by the heavy rain falling on low ground between the 
back of the hospital and the officers' barracks, or by emanations from a swamp 
containing much vegetable matter, and communicating with the sea, about a 
mile to the windward of the regimental hospital. 

" The doctrine of the contagious nature of fever is in my mind so erroneous 
that I should not dwell thereon were it not with the view of enabling you to 
refute, so far as my feeble efforts can, the opinions entertained in reference to 
the origin of the fever on this particular occasion. In the first place, if the 
principle of contagion existed in the ' Hercules ' (which I cannot admit, 
though I believe such to have been stated by Captain Nicholas), whether is it 
more reasonable to believe that it was brought on board by the soldier of the 
62nd, who died without any characteristic sign of Yellow Fever, or by Major 
Cross, who died with a ' black vomit' three days after he embarked, and had 
a rigor the night before he left the garrison ? Captain Nicholas, however, 
seems to think otherwise, and blames the unfortunate soldier of the 52nd for 
an alarming fever which affected some of the officers of his ship whilst conveying 
the 36th Kegiment from Barbados to Halifax, but he omitted to state whether 
any were attacked but those who had dined with the officers of the 52nd at 
Barbados, and thus been exposed to the cause of fever existing in the locality 
of the mess-room, which question you will admit as one necessary to be decided 
before giving adherence to his views. Whilst on this subject, it may be well 
to attract attention to the fact that whilst the 52nd Regiment suffered so much, 
none of the other troops in garrison were in the least affected, which I think 
must have been the case had it been a contagious disease, brought by them 
from Gibraltar, for there was no cordon placed around the barrack, nay, indeed, 
all the sick soldiers were treated under the same roof as the soldiers of the 69th, 
and, to the best of n)y recollection, that regiment had but one case, and that 
occurred in an old soldier long seasoned in the country, who was lent by 
Colonel Monins to the officer suddenly called upon to perform the duties of 
paymaster, upon the death of Mr. Winterbottom. This poor man wTote in 
Captain French's room one day, and was dead three days afterwards. Now 
Captain French never had fever. 

On the 1st November, 1839, cases of this peculiar form of fever again 
appeared in the 52nd, taking a progressive course directly with the wind from 
the hospital (the serjeant and orderlies of which were first attacked), in a 
straight line across a swamp to the barracks. On this occasion the officers' 
quarters yielded three fatal cases only, and the disease appeared pi'etty gene- 
rally through the soldiers' barrack, and in the huts occupied by the non-com- 
missioned officers and married people. Thus, although the influence of the 
cause seemed to travel in a more extensive vein than in the previous year, yet 
the pestilence was almost entirely again confined to the quarters occupied by 
this regiment, as only three fatal cases occurred amongst all the other troops in 
the garrison. Therefore, at the recommendation of Mr. Draper, Inspector- 
General of Hospitals, the 52nd were moved to an encampment about a quarter 
of a mile to windward of the swamp before mentioned, instead of being to 



Epidemic at Galveston. — Barcelona Manifesto. 



233 



leeward ; and no case was admitted for a fortnight after the move, and, indeed, 
only three fatal cases occurred subsequently, and the individuals had been 
employed at the barrack. 

" I am, &c., 

" Thomas Spence, M.D." 



Letter (N.) 

The following is an extract from a pamphlet on the Yellow Fever at Galveston 
(Texas) in 1839, hy Dr. Ashhel Smith. 

This gentleman had studied in Paris, and was some 10 years ago employed 
as envoy from Texas to the British Government, he says : — 

" The exclusive confinement of the disease to persons much exposed in the 
infected district, the frequent removal of the sick from this district to the 
nealthy parts of the city, without communicating the disease to the attendants 
or any other persons whatsoever, strongly confirm the opinion of its non- 
contagiousness. 

" The local causes are the decomposition of abundant animal and vegetable 
matters, going on under and around the houses on the ' Strand,' and the exha- 
lations from the extensive adjacent marsh and quagmire, exposed to an ardent 
sun, whose thermometrical range in the coolest shade for several hours daily, 
has been from 84 to 89 degrees of Fahrenheit. 

" The sick have been in numerous instances removed from the infected dis- 
trict to the healthy sections of the city, and in no case, as far as I can learn 
on careful inquiry, have the attendants or inmates of the houses contracted the 
disease. On the contrary, the city, with the exception of the infected quarter, 
has enjoyed its unsurpassed general healthfulness. 

" I have made several post mortem examinations, handling every organ 
without squeamishness, immersing my hands freely in the black vopjit and 
other fluids, smelling and viewing them closely ; I have repeatedly tasted 
black vomit when fresh ejected from the stomachs of the living ; 1 am not 
aware of ever having experienced further inconvenience or effect than fatigue. 

" Of the physicians who practised in this disease all escaped an attack 
except two ; these two resided in the infected district ; the others lived with- 
out it. 

" After a careful observation of the history of the epidemic, no fact has 
come to light which would show that the disease is contagious, that it is com- 
municable from a person labouring under it to one in health, but that it is 
contracted only by exposure in the infected district. 

" The subject of contagion is one of great importance. A belief in the con- 
tagiousness of this disease would deprive the sick of the most necessary atten- 
tions ; non-contagion destroys many of the horrors of an epidemic, as a removal 
only a short distance places us beyond its influence." 



Letter (O.) 

The following is a Resume of the very valuable Manifesto of the 15 Physicians 
present at the Yelloio Fever epidemic of 1821 at Barcelona. 

" From all that has been stated it results — 

1. That the fever which prevailed in Barcelona in 1821 was indigenous, 
"2. That it was epidemic. 

3, That it was not contagious. 
" 4. That the sanitary measures adopted by the Government were precarious, 
wholly useless, and even prejudicial, if we except that oi' emigration. 

R 



234 Manifesto of Fifteen Physicians at Barcelona. 



" 5. That if, instead of remaining in a shameful inaction, expecting to knock 
on the head an invisible and imaginary contagion, unknown in its essence, and 
impossible to be demonstrated, all the means calculated to remove the local 
causes, w^ere employed with constancy and energy, it might be hoped that the 
disease would not re-appear ; that this beautiful capital would recover the degree 
of salubrity which it was formerly wont to enjoy ; and that commerce and in- 
dustry, in a word, that prosperity extending not only to all Catalonia, but to 
the whole of Spain, and even to the most distant nations, would revive. 

^'Barcelona, February 21, 1822." 

Lassis (Simok), D.M., of Paris, (a) 
RocHoux (J. A.), D.M., of Paris, {h) 
FnAifcisco PiGuiLLEM, M.D., of Barcelona, (c) 
Frat^cisco Salva, M.D., of Barcelona, {d) 
Mai^ual Dubak^, M.D., of Barcelona, (e; 
Juan Lopez, M.D., of Barcelona, {f) 
Salvador Campmany, M.D., of Barcelona, {g) 
Ignacio Porta, M.D., of Barcelona, (h) 
Jose Calvebas, M.D., of Barcelona, (i) 
Antonio Mayner, M.D,, of Barcelona, (k) 
Raymundo Duran, M.D., of Barcelona, (I) 
Buenaventura Salmo, M.D., of Barcelona, (m) 
John Leymerie, M.D,, Citizen of the United States, (w) 
Thomas O'Haeloran, M.D., British Army, (p) 
Charles Maclean, M.D., of London. 

" N.B. — In order to obviate misconception, I think it right here to observe, 
that the first edition of the Manifesto, published at Barcelona, had only thirteen 
signatures, Drs. Leymerie and O'Halloran having left that city before it ap- 
peared. Their names were, however, added on the publication of the Madrid 
edition, augmenting the signatures to jifteen, being the original number of our 
spontaneous association." 

(a) " Formerly Physician to the French Armies, and Physician-in- Chief of the 
Hospital of Nemours ; author of " Recherches sur les veritables causes de Maladies 
epidemiques, appelle'es Typhus," &c. Paris, 1819. 

(&) " Member of the Medical Commission sent by the French Govermnent to 
Catalonia ; formerly Physician en second to the ]Military Hospital of Fort Royal, 
Martinique ; author of " Recherches sur la Fievre Jaune, et Preuves de sa non con- 
tagion dans les Antilles." Paris, 1822, 

(c) " Vice-President of the Sub-delegation of Medicine ; Clinical Professor ; 
member of various learned bodies ; an eminent practitioner, who, after having dis- 
tinguished himself as a writer in favour of pestilential contagion, had the magna- 
nimity to avow his conviction of the truth of the opposite opinion. 

(d) " Honorary Physician to the King ; Clinical Pi'ofessor ; Dean of the Faculty 
of Medicine of Barcelona ; member of various academies. This venerable phy- 
sician has been justly celebrated by Townsend for his courage and humanity in 
resisting, happily with success, a despotic and barbarous mandate of the Court, 
directing the exclusive administration of a nostrum of the King's physician, during 
a pestilence at Barcelona. 

(e) " Member of the Academy of Practical Medicine ; a convert from conviction 
at an advanced period of life. 

(/) " Member of the Superior Junta of Sanidad of Catalonia ; a man of great 
experience, modesty, and discernment ; a convert from conviction. 

(g) " Member of the Academy ; Physician to the Military Hospital ; the first to 
volunteer his services to attend the patients in the foul lazaretto. At the com- 
mencement so thorough a believer in contagion, as to have worn an oil-cloth dress. 

(A) " Member of the Academy of Practical Medicine. 

(i) " Member of the Subdelegation of Medicine. 

(k) ••' A respectable practitioner, who occasionally exercised his talent in satirising 
the " sanitary" proceedings of 1821. 
(Z) Physician to the General Hospital:; wrote occasionally against the doctrine 



Fever at St.Andero in 1813. 



235 



of pestilential contagion in the journals ; had hinaself the fever, in which he was 
attended by Dr. O'Halloran and myself, in consultation with ten or a dozen of our 
Barcelona colleagues. Extreme unction had been administered, but happily he 
recovered, to the great satisfaction of all his professional brethren, as well as to the 
benefit of our joint manifesto. 

(m) " Physician to the General Hospital ; had double labour during the latter part 
of the epidemic on account of the illness of his colleague, which he performed with 
much cheerfulness. Animated with a laudable anxiety to give information respect- 
ing the affairs of his department. 

{ti) " Formerly Physician in chief to theHospital of Santiago in Paris, member of 
various learned societies, and attached to the American legation at Madrid. 

(o) Member of the medical academies of Madrid and Barcelona ; author of two 
works on the epidemics of Spain ; a volunteer, with permission of his Eoyal High- 
ness the Duke of York, to investigate the fever of Barcelona, and to succour its 
suffering inhabitants." — Maclean's JSvils of Quarantine Laws. 



Letter (P.) 

For a full Account of the Appearance of Yellow Fever at St. Andero in 
1813, see the Thesis of Dr. Bones Son, Dr. Hugh Bone, of the medical staff. 
(Edinburgh, 1846), p. 19. 

" In the autumn of 1813, being the close of the Peninsular War, sporadic cases 
of Yellow Fever appeared in the depot barrack in St. Andero in Spain, and 
after the Christmas holidays became numerous. The barrack was inspected 
by Dr. Erly and by Dr. Bone, and was supposed, from the foul state of the 
sewers and privies, to be unhealthy. The troops were removed to a healthy 
situation, and soon became healthy. But the removal of the troops attracted 
the notice of the Spanish authorities ; their board of health inspected the 
British hospitals, and pronounced the disease to be Yellow Fever, and con- 
tagious. The British medical officers were unanimously of opinion that the 
disease was not contagious ; but the patients who were yellow were selected 
and put in quarantine in moveable hospitals in a healthy situation. Dr. Bone 
was in charge of the quarantine hospitals. Fifty of the patients were yellow, 
and eleven of them died, and were all carefully dissected by him or by his 
assistants, yet none of them caught Yellow Fever, nor any of the other 
patients in the quarantine hospital, nor any of the hospital servants or washer- 
women, nor any of the patients or servants in the hospital from which the 
yellow pa-tients were taken. He calculated that 700 persons had been exposed 
to the influence of the disease, yet none caught Yellow Fever. The cordon of 
troops did their duty, the British strictly, the Spanish with ferocity, but could 
not prevent all intercourse with the quarantine hospital. 

" The president of the board of health had been a professor in one of the 
Spanish universities, and was learned, and, for a Spaniard, liberal and not 
bigoted. Having repeatedly and minutely examined the Yellow Fever 
patients in the quarantine hospital, he changed his opinion, and declared the 
disease to be non-contagious or little contagious, and in many cases only 
jaundice. The junta fined him for altering his opinion ; he carried on a paper 
war with them ; the argument was in his favour, but the power was against 
him, and they levied the fine ; but the British officers in St. Andero, thinking 
it unjust that the professor should be fined for declaring the truth, raised the 
sum by subscription, and presented it to the professor, with a kind and well- 
penned letter by Dr. Erly, and the professor was compensated for the perse- 
cution of his bigoted countrymen." 



236 Letters of Drs. Adolphus, and Macnamara, on " Iphigenia.^^ 



Letter (Q). 

Dr. John Wilson, R.N., at page 142 of his book on West Indian Fever, 
referring to the case of the " Iphigenia," at Port Royal, Jamaica, on board of 
which Yellow Fever had appeared in February 1820, furnishes a letter from 
Dr. Bancroft, Deputy-Inspector of Hospitals at that island, addressed to Rear- 
Admiral Sir Home Popham, in which we have the following paragraph : — 

" All we have been able to discover in its history and progress tends to 
convince us that the fever in the ' Iphigenia' has neither originated in, or been 
propagated by, contagion." 

At page 144, Dr. Wilson furnishes a copy of an official document from 
Dr. Adolphus, Deputy-Inspector of Hospitals at Jamaica, 4th February, 1820. 
After stating that he had made a most minute inspection of the " Iphigenia," 
Dr. Adolphus says : — 

" From the observations my experience of the diseases of this climate has 
enabled me to make, it appears that at least nine-tenths of European subjects, 
whether in civil or military life, are not only liable to, but are actually seized 
with fever within the first 12 or 15 months after their arrival in a tropical 
climate ; that when the disease has once shown itself among a considerable 
body of men (as in the army and navy) it is sure to spread with unerring cer- 
tainty to a greater extent, and under a more aggravated form, than when persons 
in civil life are the subjects of its attacks ; not from any contagious properties, 
which I distinctly and wholly deny, but occasioned by the dreadful presenti- 
ments which the men invariably encourage under such circumstances by that 
terror of disease which is sure to predispose the constitution to febrile attacks, 
upon the slighest deviation from the established rules for the preservation of 
health, amongst persons unassimilated to the climate. 

" When it is considered, therefore, that the crew of the ' Iphigenia' had 
never undergone what is emphatically called ' a seasoning,' in its terrific form 
it is not to be wondered at that sickness should at length make its appearance 
among them. 

With regard to the nature of the fever, I consider it, what time has 
proved it to be, the indigenous offspring of this climate ; and its degree of 
mildness and severity to depend on the circumstances of season, of locality, 
and constitutional temperament ; and, lastly, I consider the fever to have been 
produced by increased temperature and other atmospheric causes. 

J. Adoephus, M.D., 
" Deputy-Inspector of Hospitals.-^ 

Dr. Wilson next gives, page 145, a letter from Surgeon Macnamara, of the 
Naval Hospital, Port Royal, Jamaica, dated 7th February, 1820 : — 

" Naval Hospital, Port Royals 
Sir, " February 7, 1820. 

On the 14th of last month, when I had the honour of waiting upon 
you on board of His Majesty's ship ' Sybille,' the number of patients in this 
hospital amounted to only 17, the greater part of whom were convalescent. 
However, it is with infinite regret I find it my duty to state for your informa- 
tion that on the evening of that day two petty officers were received from His 
Majesty's ship ' Iphigenia,' labouring under fever, the symptoms of which were 
of so marked and unequivocal a nature as to induce me to represent to Captain 
Parker the absolute necessity of his proceeding to sea, to avert, if possible, the 
extension of the disease, which seldom fails of communicating its baneful influ- 
ence to the whole of any ship's company where it has once displayed itself." 

[He then states that, in consequence of his recommendation, the ship put to 



Dr. King on the Eclair' and Boa Vista.'' 237 



sea, but returned at the end of four days, the disease having continued to pre- 
vail on board.] 

" Immediately on her arrival, 13 cases of fever vrere sent to the hospital." 

[He then proceeds to state the number of daily admissions and deaths up to 
the 6th of February, the total number of admissions from the ship being 121, 
30 of w^hich proved fatal, and continues : — ] 

" Notvv'ithstanding every inquiry vi^hich I have been able to make in endea- 
vouring to ascertain the remote cause of this destructive malady, it still con- 
tinues to elude my research, nor have other medical gentlemen of great talent 
and experience been more successful in theirs. 

" Indeed, sir, it is difficult to account for the generation of disease in a ship 
so vrell regulated, and in such a state of high discipline, as the ' Iphigenia ; ' 
and I am most positively and decidedly of opinion that the disease, which has 
already committed such ravages on board that ship, is to be solely attributed to 
a particularly vitiated state of the atmosphere, the influence of which has been 
experienced along the whole of the American coast, from the northern bank of 
the Orinooko to Boston in New England, and in the adjacent islands. 

" With respect to the local management on board the ' Iphigenia' since the 
appearance of this disease, every precaution which human foresight and expe- 
rience of the past could devise has been had recourse to, to prevent, if possible, 
the extension of so insidious an enemy. Her hold has been cleared, and fires 
kept constantly burning therein, and I can with confidence assert that her 
timbers are at this moment as dry as the head of her mainmast. 

''J. Macnamara, 
" To . " Surgeon of the Naval Hospital. 

(Name of superior officer not given with this letter.) 

At page 152 Dr. Wilson enters into his views as to the cause of Yellow- 
Fever on board ship, which he attributes to a particular decomposition of the 
timbers, spars, &c., on board. This part of the subject, however, involving 
somewhat of theory, cannot here be entered upon with advantage. 



Letter (R). 

On the reappearance of fever at Boa Vista in 1846 the Lords of the 
Admiralty ordered Dr. King, R.N. , I believe one of the most experienced 
in Yellow Fever of the Naval Medical Officers, to proceed to that island for 
the purpose of affording assistance, and also to investigate any circumstances 
regarding the outbreak of fever in the preceding year as connected with the 
visit of the " Eclair." This gentleman, in his report, printed by order of 
the House of Commons, 10th March, 1848, says, page 1, " I venture to pre- 
sume that I have succeeded in establishing arguments in support of my own 
views, deduced from indubitable facts, which remain altogether unnoticed in 
the report of Dr. M'William." 

The "instructions" to both Dr. M'William and Dr. King were. I under- 
stand, precisely similar, but it does not appear that the replies from each were 
given categorically. The latter gentleman is most circumstantial in his details, 
as, for instance, where he states (page 9 of his report) : — " That the common 
air which was inhaled by every living thing on the island was in an epidemic 
condition in the months of October, November, and December, in both years, 
is sufficiently demonstrated by the simultaneous occurrence of universal sick- 
ness and great mortality among the cattle (including cows, horses, mules, 
donkeys, and goats), at the very time that fever was raging among the inha- 
bitants. And further, there was this remarkable coincidence, that after an 



238 



Commission at Albany > U. S., 1845, 



interval of some months, and the disappearance of disease both in man and 
beast, the same fever broke out again in the towns and villages about the rainy- 
season in the following year, and was again accompanied by the same murrain 
among the cattle, which in the two seasons proved fatal to two-thirds of the 
whole stock of the island." 

He states that, though not having personal opportuiaities of observing, he 
ascertained to his satisfaction that the disease which prevailed at Boa Vista 
was essentially the same as that which prevailed in the "Eclair:" that he 
examined at Boa Vista all the survivors said to have had connection with the 

Eclair," as labourers, washerwomen, and soldiers ; this was carefully done 
and their statements drawn up in the presence of the senor Baptista, and 
John Jamieson, the interpreter, who was the consul's storekeeper. He states, 
that the labourers attacked had not been exposed to contagion had such a thing 
existed ; and that the fever was not communicated to the persons in the house 
into which the sick British officers and their servants had been received. 

Dr. Almeida of Boa Vista, considered the disease alluded to as an aggra- 
vated type of the bilious remittent, and in such belief positively continued, 
as stated to me by Dr. King,* until after the arrival of a communication to 
him from the British Superintendent of Quarantine. 

Finally, Dr. King has come to the following conclusions (page 7 of report). 
' ' It becomes therefore a duty to express my opinion decidedly that there is no 
satisfactory proof of the disease having been propagated by contagion or from a 
specific poison, which is said to emanate from the bodies of the sick, ' the 
dying, or the dead ' " (page 13). "And I must now declare my belief firmly, 
but conscientiously, that the Yellow Fever is not a contagious disease." 



Lettek (S.) 

In consequence of petitions from many citizens of New York, the House 
of Assembly appointed a Select Committee in relation to the Quarantine 
Laws to assemble at Albany in 1845. The members of the Committee were 
D. e'. Wheeler, C. Corastock, and E,. H. Hine. Their Report is dated 
January 22, 1846, 

At page 40 of the volume in which their proceedmgs are published we find 
the following observation : — 

" The voice of mankind has called for relief, for in many instances quaran- 
tine regulations have been not only oppressive to commerce, but pestilential 
sources of disease and death." 

Yellow Fever seems to have occupied the special attention of the Committee, 
and several respectable physicians of experience were called upon to furnish 
testimony as to the contagious or non-contagious property of that disease. 

At page 171 of the proceedings, Dr. Hort, of New Orleans, states : — 

" The facts, as presented by Dr. Beck, of New Orleans, in relation to the 
fever of 1822 in your city (New York), are of themselves sufficient to settle 
the question of contagion for ever ; for the Yellow Fever cannot be contagious 
at one time and non-contagious at another ; in short, the evidence that Yellow 
Fever is not a contagious disease, and therefore cannot be communicated by 
personal contact, is overwhelming I do not know a single physician in 



* From the same authority it appears that Dr. Almeida was a general merchant, 
who sold in his store a few simple drugs, and gave his advice gratis. It may hence 
be inferred that his opinions, even had they been fixed, could have been of no great 
value. 



on the Quarantine Laws. 



239 



this city (New Orleans) who believes it to be contagious; and the public, with 
very few exceptions, are of the same opinion ; and it would be difficult to find 
a physician of a different opinion at Havana, Vera Cruz, in the West India 
Islands, or, in short, in any part of the world where Yellow Fever prevails. 
We know of no malignant fever pecuHar to tropical climates that is contagious ; 
they ail result from imimrity of the atmosphere, occasioned by exhalations from 
the surface of the earth." 

At page 197: — 

" Since the first time I saw a case of Yellow Fever, in 1822, to the present 
time, I have not seen the least evidence to prove that Yellow Fever is con- 
tagious ; but facts have been constantly accumulating to prove the reverse. In 
this city my experience has been chiefly among the Irish and German emi- 
grants ; I have generally found them very much crowded, and particularly the 
Irish. In several instances, where, perhaps, 20 or 30 persons occupy two or 
three small rooms, and all unacclimated, I have attended five or six with the 
Yellow Fever, while all the rest, although in constant contact with the sick, 
have escaped the disease. How could this happen under such circumstances 
so favourable to the propagation of the disease if the fever were contagious?" 

There may be two or three physicians in this city who believe that Yellow 
Fever is contagious ; but in opposition to this opinion the faculty may be said 
to be almost unanimous. Sporadic cases of Yellow Fever are utterly repugnant 
to the doctrine of contagion. Until within three years past, during which time 
the fever has been rather sporadic than epidemic, the Yellow Fever prevailed 
with regularity as an epidemic every other year, but there were always sporadic 
cases." 

In the course of the investigation many observations for and against contagion 
were brought forward, but the necessary limitation to my Report prohibits 
my giving any further extracts from the proceedings than the following 
evidence of Dr. Ileese, of New York : — 

" The Yellow Fever never was, nor ever will be, imported into this port, by 
sea or land, in the persons of the sick, for the reason that it is not a contagious 
fever, as small-pox is — that it is not communicable from the bodies of the sick 
to the healthy. It can only be im.ported n the holds of vessels, nor is there 
any danger of cargoes or persons. 

" The Yellow Fever is not communicated by personal contact, but by an 
infected atmosphere. 

" No number of the sick can so infect a healthy atmosphere as to produce 
Yellow Fever, though other diseases may be produced by foul air ; but if the 
air of a neighbourhood be infected by the cause of Yellow Fever, which is a 
specific poison, all persons breathing it any length of time are liable to be 
attacked, even those who only visit the infected district for a few hours. But in 
all cases the line may be readily drav/n, circumscribing the infected district, and 
beyond which perfect impunity may be enjoyed, even though in contact with 
the sick and dying, who have been removed from the epidemic atmosphere. 
.... And yet I have at another time lived and slept in the midst of the sick 
and dying of the Yellow Fever, who had been removed into a healthy situation, 
without witnessing a single instance of infection among physicians or nurses ; 
and but for the antiquated superstition of the times, there would be as much 
reason for prohibiting a passenger whose leg was broken from being brought 
into the city as one sick with Yellow Fever. Indeed, there is quite as much 
danger of catching a broken leg in the one case as the Yellow Fever in the 
other." 



240 



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242 



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[ 245 ] 
Appendix No. II. 



REPLY OF T. JONES HOWELL, Esq., 

Jxidge Advocate, and Judge of the Vice Admiralty Court of Gibraltar, and one of 
the Members of the Board of Inguiry, instituted for the purpose of ascertaining the 
origin of the Yellow Fever epidemic o/'1828 in that Garrison. 

ADDRESSED TO 

SIR GEORGE MURRAY, 

Tlien Secretary of State for the Colonies; who had requested 
(17 Sept. 1829) Mr. Howell to state Ms reasons for arriving 
at the opinion forwarded by him at the conclusion of the 
proceedings on that occasion, which was as follows : — 

"Upon a careful review of all the proceedings 
before this board, i am of opinion that the evidence 
brought forward has totally failed to prove that the 
late epidemic disease was introduced from any foreign 

SOURCE, EITHER BY THE SwEDISH SHIP ' DyGDEN,' OR BY 
ANY OTHER MEANS, AND I AM FURTHER OF OPINION THAT 
THE LATE EPIDEMIC HAD ITS ORIGIN IN GIBRALTAR. 

Gibraltar, 30th April 1829. T. JONES HOWELL." 

The above is the conclusion at which I have arrived, after 
weighing the credit of the different witnesses, and the credi- 
bility of their evidence. To the expressions of the particular 
witnesses, and to the manner in which their testimony was 
delivered, I paid minute attention, and I took careful notes of 
their viva voce statements, at the very moment these were 
uttered. Having thus closely scrutinized the credit of the 
witnesses, their demeanour in giving evidence, and the charac- 
ter of the testimony itself, I am compelled to declare that I 
entirely disbelieve much of that testimony. 

Two causes concurred to operate injuriously upon the pro- 
ceedings of the Board : First, the conviction universally pre- 
valent among the civil population of Gibraltar, that the 
prosperity of that community would be undermined if it 
should be proved that the epidemic had been generated on the 
spot, because of the prohibitions and restrictions which it was 
anticipated would in that case be inflicted upon its commercial 
intercourse with other places. Hence the notion that not only 
the last epidemic, but that all its predecessors had been im- 
ported from some foreign country was not only anxiously sup- 
ported by the unanimous voice of the civil community, but it 
was with equal unanimity believed that a different doctrine 
would be fatal to the commercial prosperity of the place. 
From this feelins; of self-interest it is to be admitted that 



246 



Cases of Fenic^s Children. 



tlie military were exempt^ a distinction between tlie two classes 
wHch ought to be taken into account in estimating the value 
of the evidence taken bj the Board, and more especially the 
evidence of the medical practitioners. 

The second cause operating injuriously upon this inquiry, was 
the publication, in the of&cial Government newspaper (into 
which nothing is admitted except by official authority), on 
January 12, 1829, of an article authoritatively announcing 
that the late epidemic had been imported into Gibraltar, and 
denouncing as void of common sense any person who should 
hold a different opinion. This official notification of the feel- 
ings of the local Government (preceding as it did by only 12 
days the appointment of the Board of Inquiry) could hardly 
fail to encourage evidence on one side, and discourage evidence 
on the other. 

Bearing these circumstances in mind, I proceed to consider the 
evidence which was adduced to prove that the first case of the 
epidemic had its origin in some source foreign to Gibraltar. 

That which was represented to the Board as having been the 
first case of the epidemic, came so represented by a low Spanish 
practitioner, Cortes by name, but better known by the class 
of people among whom he exercised his calling by the appella- 
tion of ''Johnny the Bleeder." 

The report of Cortes is in these words 

" Return of the first case of fever under my treatment : — 
" On the 9th day of September, 1828, Rosario Cortes, my 
young daughter, College Lane, No. 10, — Epidemic Fever. 
N.B. Some days before Dr. Braulio Lopez got sick, I was 
informed by him that the two sons of Felix Fenic, named 
" Salvador Fenic and Catalina Fenic, had died of the black 
vomit, in district No. 24. The former died on the 17th of 
August, and the latter on the 20th of the same month. 

" John Cortes, Surgeon'' 

I am aware that by some who deny that the disease was im- 
ported, it has been asserted that these cases of Fenic's children 
were not the earliest cases of the epidemic ; but no earlier case 
having been instanced to the Board, I shall assume that Salvador 
Fenic was the first patient afflicted with the epidemic, this 
being the position taken by those who assert that the epidemic 
was imported. 

In examining the evidence which was given for the purpose 
of tracing the illness of Salvador Fenic to a foreign origin, it is 
necessary to be particularly observant of dates. 

By the return of deaths in the Catholic persuasion, signed 
by the Catholic vicar, it appears that "Salvador Fenic, aged 
" 13, died August 17th" (which will be found in that year to 
have been Sunday)-, "Catherine Fenic, aged 10, died August. 



Alleged Importation through Fenids Children. 



247 



'•20" (Wednesday) ; and Felix Fenic," the father, '^aged 50," 
died not until September 7." 

Evidence was first adduced to the Board touching the his- 
tory of this family on the 8th of April 1829, when Margarita 
Villalunga stated that she '-'lived in the yard of Fenic's house : 
'' the boy took ill on Monday, and died the following Sunday." 
As we have seen that the day of the boy's death was Sunday, 
August 17tli j this witness fixes the day of his attack to have 
been Monday, August 11th. '• The girl took ill the day the 
" boy died," viz., Sunday, August 17th, " and died the Wed- 
nesday following," viz., August 20th. 1 heard the boy say 
that he, his sister, and his father," here is no mention, be it 
observed, of any other person, " had been on board a ship in 
the bay on the Sunday, the day before the boy took ill," viz., 
Sunday August 10th; '* the boy told me they had been on 
" board to eat, drink, and make merry on the Sunday : the 
" following day the boy was taken ill. I never heard what 
nation that ship belonged to. I was told hy the hoy that his 
father had sold some tobacco on board that ship, about an 
arroba* of cigars as a sample, and if approved, having about 
30 quintals! of cigars, he had hopes of selling the whole to the 
same ship." 

This expression leads to the presumption that the ship, so 
alleged to have been visited, could not have been laden wholly, 
or in part, with tobacco. We must therefore attribute to some 
ship not so laden, but coming from within the prohibited 
degrees of latitude, the origin of the epidemic, if we believe it 
to have been imported by this family. 

The witness added, " the father Felix Fenic, formerly had 
" been captain of a ship, and was latterly a manufacturer of 
" cigars." She was then examined as follows : — 

" Do you know if he was owner of a boat in August last ? — 
" His eldest son Joseph, about 22 years of age, was owner of a 
" boat at the time the other children were taken ill and died. 

" Do you know whether the children that died went on 

board in their brother's boat? — I do not know. 

" Did any body else go on hoard loith them ? — I do not knoio !" 

This last question and answer I consider to be material 
with reference to the subsequent evidence of the boy Caffiero. 
This question and answer not being set down in the minutes, I 
have transcribed them from my own notes. 

The witness then described herself to have been employed 
by Fenic, as a sort of journeywoman, in the making of cigars, 
and the remainder of her evidence as delivered at this time 
(April 8th) in no way relates to the subject under considera- 
tion, viz., the introduction of the epidemic into Fenic's family. 

* An arroba is equal to 26 lbs. Gib. price current. 
f A quintal at Gibraltar is equivalent to a c"vrt. Ibid. 



248 



Evidence in support of 



The next witness examined upon this point was Cortes, the 
Spaniard already noticed. He stated that " Salvador Fenic, the 

son of Felix Fenic, about 12 or 14 years of age, was taken ill on 

the I2th of August, and died on the 17th. His sister Catalina 
" Fenic, took ill on the day that the boy died. She died on the 
" 20th August. Dr. Braulio Lopez loko is dead,'" (these three 
words, Avhich are omitted in the minutes, I have supplied 
from my own notes,) " informed me some days before he fell 
" ill himself, that he attended these children, and that the dis- 
" ease of which they died was the reigning fever." But the 
witness Villalunga had previously stated that she was present 
when Dr. Lopez had pressed the girl's stomach and belly, and 
caused her to vomit black matter, and the doctor said it was 
owing to her having eaten figs. 

I observe that the only important facts narrated by these 
two witnesses, they allege to have heard from two other per- 
sons, both of whom were dead at the time this evidence was 
given, and upon one important particular they are directly at 
variance. 

The next witness upon this subject was the child Caffiero, 
whose evidence was given on the 10th of April. This boy was 
the first patient entered in the list of epidemic cases treated in 
the Civil Hospital. He is there stated to be 11 years old, and 
to have been admitted August 21 (Thursday). The story now 
told by this boy, is that he was in the habit of playing with 
Salvador and Catalina Fenic every day before their death ; that 
he lived very near to them ; that he was taken ill tico days 
hefore he went to the Civil Hospital ; that he saw Salvador and 
Catalina Fenic every day when they were sick in bed, the boy 
first, and the girl afterwards ; that he saw the girl for the 
last time on a Saturday, " and the next day, Sunday, I fell 

ill myself; she was sick and in bed; the boy was then 
dead." These dates disagree with the journal given by Villa- 
lunga, of the events in Fenic's family ; according to her, the girl 
was not ill on the Saturday, and the boy was alive on that day. 

The only evidence which up to this period (April 10th) had 
been given to connect the illness in Fenic's family with a visit 
on shipboard, is the hearsay tale told by Villalunga, nor did 
she give to Fenic and his two children any companion in their 
alleged Sunday excursion. 

Here this branch of the inquiry at that time terminated, and 
other matters were taken up. 

Eight days after his examination above mentioned, the boy 
Caf&ero re-appears as a witness (viz., April 18th) with a story 
entirely new, and which, if credible, would be extremely 
material ; because he affects to speak of facts which had before 
rested on the hearsay evidence of Villalunga, but of which 
facts Caffiero now, after a lapse of eight days, represents him- 



Importation through Fenics Children. 



249 



self to liave been an eye-witness. On this his re-appearance, 
however, he carefully abstains from giving any date, either 
day of the week or month, or even season of the year. This 
cautions avoiding of dates may not unfairly be attributed to 
the variances between himself and Villalunga^ in their re- 
spective journals of the illness of Fenic's children. 

CaflS.ero now says^ I knew Salvo and Catalina Fenic^ and 

went on board ship with them ; I do not recollect the day. 

We went on board a three-masted ship. I do not recollect to 
" what nation it belonged. We remained on deck, and did not 
" go below. We remained on board about one hour. Fenic, the 
*' father, took us on board ; he rowed the boat himself ; he ate 

and drank on board, and then brought a bundle of clothes on 
" shore."" I have already shown that Villalunga ascertains the 
day of the visit of Fenic and his children on shipboard to 
have been Sunday August 10th. Caffiero now fixes the class 
of ship to have been one with three masts. On reference to 
the official return^ I find that the only ship with three masts, 
not laden wholly or in part with tobacco, from any Yellow 
Fever latitude, on this 10th of August, was the Swedish ship 
^^Dygden." 

The boy^ however, says nothing about selling cigars to the 
ship, nor had either he or Villalunga until this time said any- 
thing about a bundle of clothes. 

This boy's second evidence thus proceeds : — ^'I did not un- 

derstand the language of the people on board that ship ; they 
^' appeared to speak like Jews or Moors. I did not go on 

board more than once. When we landed on the wharf, the 
" Maltese," i. e. Fenic, gave me some money, a jpistoreen* and 

told me not to say anything to anybody about our having been on 
" hoard:' 

The efiect which this was designed to produce is obvious, viz., 
that the ship visited was in quarantine, and Fenic, the Mal- 
tese, was conscious that he had committed an offence against the 
quarantine laws which rendered it necessary for his own safety 
that he should bribe this boy to secrecy. This story is full of 
incongruities ; it is not probable that a man should select, for 
his Sunday excursion, to eat, drink, and make merry, a ship in 
quarantine; it is more improbable still that Fenic should 
gratuitously place himself in extreme peril, by taking with 
him (to be witnesses of his offence) children of the artless ages of 
10, 11, and 13, on an expedition which in his own judgment, 
as demonstrated by his own act, he is convinced exposes him 
to severe punishment. 

But with regard to the ship Dygden," I find that she had 
already received pratique, and had been admitted to free inter- 
course with the shore, on the 6th of August,/(?!(r days -previously 

* The fifth part of a Spanish hard dollar. 

S 



250 



Evidence concerning the Fenics, 8^c. 



to the alleged visit of Fenic, tlie date of which, notwithstanding 
Caffiero's loss of memory on his second examination, had already 
been ascertained by Villalunga to have been Sunday, August 
10th, on which day Fenic therefore could commit no crime by 
going on board ; and the story of the bribe and injunction to 
secrecy resolves itself into a clumsy and ill-disguised attempt 
at giving a colour of guilt to a fabulous occurrence which, 
even if it had been real, would have been guiltless. 

Caffiero thus proceeds : I do not recollect how long it was 
" after I came on shore from the ship that Salvador Fenic fell 

ill and this he does not recollect, notwithstanding that, — if 
the viva voce diary given by Villalunga, of the proceedings in 
Fenic's family, tracing with mathematical precision effects to 
their causes, be true, — it must have been impossible for any one 
of the Sunday party of pleasure to disconnect the visit in the bay, 
and the consequent illness of Fenic's son on the following day ; 
and more especially for one who, like Caffiero, had (as he said on 
his first examination) been in the habit of playing with Salvador 
and Catilina every day before their death, and who saw them 
every day when they were sick in bed, Salvador first, and 
Catalina afterwards, and who said he saw Catalina for the last 
time on a Saturday, " and the next day, Sunday, I fell ill 

myself" 

It is impossible not to mark the contrast between this boy's 
evidence on the 10th and that given by him on the 18th April; 
his discrepancies with Villalunga as to dates, when he did give 
them on his first examination, showed the inexpediency of 
committing himself to dates on his second. 

His second evidence concludes thus : My mother was a 
" washerwoman, and washed for a black woman who lived 
" next her. Fenic's wife refused to wash the bundle of clothes 

that he brought ashore ; he offered them to my mother, who 

also refused them ; he then gave them to an Englishwoman : 
" 1 knew her : she is dead : I do not know her name, nor where she 
" limdr I find by my notes that he added, This occurred 
" during last winter," although the words are not entered upon 
the minutes. He was then asked, ''What season of the year 
" was it that you were on board of ship ?" To which he cau- 
tiously replied, ''It was either summer or winter, I believe." 

Evidence such as this, and given as I saw it given, bears on 
its face every character of falsehood ; and disbelieving as I do 
this boy's whole story, and at the same time considering his 
extreme youth, the testimony given by him has upon my mind 
the further operation of tainting with more than suspicion all 
the other evidence proceeding from the same class of witnesses, 
which consisted chiefly of hearsay in conversations with persons 
who had since died; because it would seem that this child 
must have been an instmment in the hands of some one of 
maturer age. 



'communicating with the Dygden.^'* 



251 



Further hearsay eTidence — still hearsay from persons who 
are dead — came before the Board on April 24th. Josefa Salinas^ 
who is described as the widow of a miner, then said, ''I rcollect 
" that Felix Fenic's daughter, who is dead, came to my house one 
" day, and icithout my asking her, told me that she had been on 
" ship board with her father and brother. This was a little 

before the epidemic. The girl might be about 12 years old ; 
" she gave me no particidars^ as I asked her no questions; she said 
" she had been sea-sick. This she told me on a Monday," 
August 11, " saying that she had been on board the day 
" before. She said that her father had been on board to sell 
' cigars, but she did not say what ship." At the close of her 
evidence, this witness added, that she had had a conversation 
with Felix Fenic himself : He told me he had been on board 

ship to sell cigars ; that he had sold an arroba as a sample, 
" and that he did not know Avhether he should sell any more. 

This is all he told me." 

For the purpose of affording some collateral support to the 
second story told by Caffiero, the following evidence was given. 
On the 24th April Josefa Gonzales said, "I know Manuel 
" Garcia, and knew the woman who lived with him : she was 
*' godmother to one of my children. I knew her mother, 
Catalina Barne, and her son, about five years old. The two 
icomen and the child are dead. They died during the epidemic ; 
" they lived in Chune Plamp's" (Fenic's) "yard, where the two 
children died, it was said, from eating green figs, about 15 days 
before the people were turned out from 24 District. Catalina 
" Barne" (whom this witness had already stated to be dead), 
" the mother of the godmother of my child, told me, before the 
people went out to the Neutral Ground, that the cause of the 
" death of the two children had been the clothes brought from 
" on board ship, and not the eating of green figs, as was 
reported ; she did not tell me that these clothes were washed 
in Fenic's house. She only told me what I have already 
stated ; and I accordingly requested Catalina Barne not to 
" come to my house any more, as I suspected there icas fever in 
" the garrison^ After giving a sketch of her acquaintance with 
Gibraltar epidemics, this witness added, She did not tell me 
that she had seen the clothes ; but she told me that she believed 
these clothes were the cause of the death of the children. I 
was told that Catalina Barne, her daughter, and her grandson 
died in A. M. Danino's-buildings. She merely told me that 
the clothes came from onboard ship, but did not say from what 
ship." She was then questioned as follows : Can you point 
" out any person who can tell us where the clothes came from ?" 
— No ; as I went out to camp, I cannot; Iicish I could,'" This 
last expression denotes the animus with which this witness 
sives her evidence — if indeed such idle gossip, to use the 

s 2 



252 



Evidence concerning the Washing 



mildest term, can be treated as evidence at all, and if the 
retailing a rumour is to be considered as proof tbat it is 
true. 

Josefa Salinas was asked, on the same day, " Do you know 
" anything about clothes having come from on board ship to the 
" house of Fenic to be washed ?" — "I do recollect having been 
" sent for by the mother of the Fenic children to wash some 
" clothes, as I am a washerwoman ; I did not go, as I was then 
" washing in the house of Mrs. Magdelena Roca. I received 

the message the Wednesday," August 13, " next after the 

Monday that I had the coversation with the Fenic girl." 
Who brought this message to you ? I received two mes- 
" sages; the first brought by Serafina, a girl then living in 

Fenic's house ; the second message, the same evening, by An- 
" tonio Jone, a Mahonese ; both these individuals are now 
" alive ; both messages were for me to go and wash some 
" clothes ; the second messenger said if you cdiTmoi comQ to-day 

come to-morrow." We have seen that these messages were 
delivered to the witness on the Wednesday {August ISth) ; 
but unfortunately for her story, however circumstantial, the 
Swedish ship ' Dygden ' had sailed to Cadiz on Tuesday 
(August 12th), one day before these pressing messages were 
sent to the witness. 

On the same day (April 24th) Margarita Villalunga re- ap- 
pears as a witness, after an absence of 16 days from the Board, 
during which interval she had ample time to revise her evidence 
and to follow out the tale broached by Caflfiero on his second ap- 
pearance. She now remembers that " On Sunday the children 
" told me that they had been on board that* day, and Monday the 
" first of them fell ill. On Wednesday " [We have already 
seen that the "Dygden" had gone to Cadiz on the preceding 
day] " Mrs. Fenic asked me to wash some clothes, which I did 
" not do, being indisposed myself. I know that Mr. Fenic asked 
" another woman who washed for Mrs. Magdalena Roca, with 
" whom I now live, to wash these clothes, which she could not 
" wash, being engaged. I was told by Mrs. Fenic that she put 
" these clothes out to be washed." I have observed that Caf- 
fiero, after eight days' absence from the Board, added to his 
original testimony so much as to give to it a new character alto- 
gether ; I now observe, that six days after Caffiero's amended 
testimony, and sixteen days after her own original examination, 
the woman Villakmga comes back with a new story, of which 
singularly enough the principal point is made to coincide with 
the alterations and emendations in the evidence of Caffiero. 

John Nichols, journeyman tailor, appeared on the same day 
(April 24th) as a witness, and gave to the Board a new reading 
of the story respecting the visit to the ship in quarantine. His 
version runs thus: I knew the Fenic family. I was their 



of Clothes from the Dygden^ 253 



" neighbour for some time. The eldest son was a ferrj-boat 
" man. One day lie came to me with, a pair of pantaloons 
" belonging to him to be repaired ; he said he had been nearly 
^' drowned^ his boat having been upset coming from a vessel in the 
" Quai^antine- ground : this was about three loeeks before the death 

of his brother and sister. I saw the children carried out dead 
" from the same house within three days of each other. I was 
" told they had died of eating green figs ; but having been here 
" in the epidemics of 1813 and 1814, I suspected that they had 
" died of the same kind of fever, and reported the circumstance 

to the late Serjeant King, who was Police- Serjeant of that 
" district. I knew the father of the Fenic family ; he was a 
" cigar-maker, and had formerly kept a bum-boat.''' 

On 25th April, Antonio Jone, water-carrier, informed the 
Board that he was sent by Mrs. Fenic to fetch a washer- 
woman, Josefa Salinas, at the time Mrs. Fenic's children were 
ill. I know nothing about the clothes that were to be washed, 

nor where they came from." 

The only remaining evidence upon this point goes to nega- 
tive the supposed visit of Fenic and the children on ship 
board, as well as the supposed connexion between that visit and 
the washing of clothes. 

Mr. Leach, clerk in the house of Cosens and Co., stated that 
he went on board the ship Dygden " the Sunday after her 
admission to pratique; now, as she received pratique on the 
6th of August, Mr. Leach's visit must have been on Sunday, 
the 10th, the very day which has been assigned for the visits of 
the Fenics and Caf&ero. Mr. Leach said he remained on board 
from 10 o'clock on that day till between 12 and 1, and that he 
saw no strangers on board, except his companion Mr. Travers. 
As the boy Caffiero had said that Fenic and the children 
remained on deck the whole time they were on board, it follows 
that if they had been on board at the time spoken to by Mr. 
Leach, he must have seen them. But as we have seen that 
Caffiero abstains from fixing any time at all, the evidence of 
Mr. Leach amounts to little. 

Victoria Ferrari (who is called by preceding witnesses 
Serafina) states, that she lived close to Fenic's family before 
the epidemic ; that she used to go there to wash Mrs. Fenic's 
clothes and her own at the same time, and occasionally to assist 
in the house during Mrs. Fenic's sickness. With reference to 
the evidence of Josefa Salinas, this witness adds that she was 
sent by Mrs. Fenic long — some months — before the epidemic, to 
ask Salinas to wash for her. " I was sent only once, and 
" Salinas did not come on that occasion. The things to be washed 
" icere clothes belonging to the house ; there were a good many 
" things, as Mrs. Fenic had been ill for some days ; when she 
" got better, she and I washed these clothes — -this was long 



254 



Evidence concerning the Washing 



" before tlie cMldren fell ill. Fenic's eldest son kept a boat. 
" Caffiero used to play sometimes with Fenic's cliildren, after 

their cigar-work was over. I have had no conversation with 
" any of the Fenic family about my examination here to-day. 
" I do not speak to the mother, and if I spoke to any of her 
" sons^ it was not about this." She was then asked, " Are you 

about to be married to any of the sons of the late Felix 

Fenic ?" and it is said that the witness seemed to intimate 
that she was. This question was evidently put to impeach the 
credit of the witness by imputing to her a motive for concealing 
Fenic's alleged connexion with the importation of the epi- 
demic, lest it might bring upon the surviving but innocent 
members of his family the execrations of the community of 
Gibraltar. I do not believe that any interested motive such 
as I have pointed at could exist ; or that it would operate to the 
prejudice of the family of any man, that evidence should be 
given of his having introduced the last or any former epidemic. 
So far as I can judge from my own observation, no popular ill- 
will would be to be apprehended by any man who should 
furnish testimony of an epidemic having been imported by 
some member of his family. On the contrary, the pertinacious 
adherence of this woman and of the widow of Felix Fenic to 
their assertions, in opposition to the wishes of the public, would 
be more likely to expose them to popular indignation, than 
would be their acquiescence in any of the stories related by the 
other witnesses. 

To show that practically there existed at Gibraltar no re- 
luctance to meet the popular wish by avowing a share in the 
importation of an epidemic, some instances occurred before the 
Board. Thus Francisca Roca gives evidence to show that the 
last epidemic was introduced by a person whom she states to 
be a sailor ; she does not indeed know where this sailor is to be 
found, nor in what months nor in what ship he came to Gib- 
raltar, but she '^thinks he is at sea," Her ignorance touching^ 
his movements is the more remarkable, because she represents 
him to be her own brother. Francisco Roca declared himself to 
be the father, and Diego Fabrica declared himself to be the uncle 
of this absent mariner ; and all presented themselves as ready 
witnesses on behalf of their relative to establish his claim to be 
an original importer of the last epidemic. It was stated in 
support of the pretensions of this invisible claimant, that he 
had come to Gibraltar in the " Dygden," and had been there 
discharged ; but unfortunately the ofl&cial return of sailors dis- 
charged from that vessel, furnished from the Swedish Consulate, 
included not his name. As I shall have occasion hereafter to 
expose further the absurdity of this claim, I quit the subject 
for the present. 

Another instance is a man of the name of Santos, to whom. 



of Clothes from the ^' Dygden? 



255 



tlie introduction of the epidemic of 1804 is attributed, wliicli 
Santos is still in Gibraltar, and is far from suffering in public 
estimation in consequence. 

Tlie only remaining witness concerning tlie introduction of 
the epidemic into Felix Feme's family, is the widow of Fenic 
himself. She was examined on 25th April. She was, at my 
desire, particularly reminded that the duty which she owed to 
society required her to disclose everything that she knew, and 
from the ingenuous manner in which her evidence was given, 
I am led to believe that she spoke the truth. 

She declared that she did not know the cause of her children's 
illness : they were attended by Dr. Lopez, who is dead, and 
" who said they had a tabardillo and indigestion, caused hy 

eating green figs. He did not say what was the cause of the 
" tabardillo. My husband was a cigar-maker ; but he did not 
*• go on board ship either to buy tobacco or to sell cigars. 
" Neither my husband nor my children went into the bay at 
^' any time during last summer or autumn. I know this, 
" because if they had gone, they would have told me, and they 
" did not tell me." * Nor indeed is it to be supposed that the 
children would not have told their mother, and that the husband 
would not have told his wife, that which all of them are declared 
to have communicated so freely to other people. 

Finally with respect to this family, it will be seen by a com- 
munication addressed by Dias, a Spanish doctor, on January 30th, 
1829, to the Secretary of the Board, that Dr. Lopez, who 
attended Fenic's children, attributed their illness to eating- 
green figs, and who, being asked whether, had they eaten green 
plumbs, the effect would have been the same, the Doctor drew 
a scientific distinction between the action of the two fruits. 
The whole letter of Dias is curious as illustrating the science 
of the Spanish practitioners at Gibraltar. 

Having thus examined in detail the evidence adduced to 
connect the illness of Salvador Fenic (the alleged first case of 
the epidemic) with the " Dygden," — and no other vessel has 
been pointed at, — 1 find not only that it completely fails to 
make out even 2i. prima facie case, but also, from the whole com- 
plexion of the evidence, I am convinced that the story of 
Fenic's visit to that vessel on the 10th of August is, from 
beginning to end, a fabrication. 

In anticipation of a failure to connect the illness in Fenic's 
family with a foreign source, much testimony was given^ 
through channels most impure, about instances in which foul 
clothes are supposed to have been brought ashore by sailors 
arriving from the Havannah, m the early part of the epidemic, 
and which foul clothes infected the washerwomen. 

Mary Parody, a woman whose claim to veracity no one 



♦ See also Dr. Gillkrest's Report, Addenda H., p. 223. 



256 



Evidence concerning the Washing 



attempts to upliold, declared that she " went to Mrs. Silcox's 
" to wash with her some clothes which were full of vomit ;" 
during which washing she (Parody) fell ill. The next day she 
returned to Silcox's and found her ill in bed. Parody then 
delivered the clothes, which herself and Silcox had the day 
before washed, to two sailors, who, although requested to wait 
until the morrow, said they could not ivait, because they were going 
away to Cadiz ; and they accordingly took away the clothes, 
still wet from the tub, on board ship. Silcox told Parody that 
the clothes belonged to the Swedish ship which had come from 
the Havannah, and that on the passage nine men had been sick 
and three had died. Parody took to her bed the day she 
delivered the wet clothes to the sailors. She had been six days 
in bed when Mr. Duguid^s coachman icas buried. Five or six 
days during her illness she was seen by the late Dr. Lopez. 
When she was getting better she went to the Civil Hospital, 
but returned the same day. 

Such is Mary Parody's story ; but perverse unaccommo- 
dating dates destroy its effect. Mr. Duguid's coachman died 
September 1st, and supposing him to have been buried Sep- 
tember 2nd, Mary Parody must have, at the very earliest, taken 
to her bed on August 26th, having delivered on that day the 
wet clothes to the sailors of the Swedish ship. The Swedish 
ship, however, had sailed from Gibraltar for Cadiz on the 
12th of August, Avhich circumstance presents an anachronism 
fatal to the narrative of the witness. 

The steward of the Civil Plospital fixes the day on which 
Parody presented herself there to have been August 30th. He 
was present when she stated her complaint to the doctor. She 
complained of a disease of the womb, for which Mr. Wilson gave 
her a powder, but did not admit her into hospital. 

Anthony Francis, a blacksmith, states that although Parody 
told Dr. Woods, a gentleman who appears to have seen her 
before she went to the hospital, that her complaint was a disease 
of the womb, she confidentially told Francis that if she acknow- 
ledged the nature of her illness to Dr. Woods, he would send 
her to the hospital, whither in fact it appears that she ulti- 
mately went, although they would not accept her as a fever 
patient. 

In corroboration of Francis' evidence, Mary Gait, a person 
of the same class as Parody herself, appeared and gave her 
medical opinion that Parody's disease was the epidemic fever. 
Parody herself stated that she had been in Gibraltar in all the 
epidemics. In that of 1804 all the family, except herself, were 
ill ; in 1810 two died in the house in which she lived, and the 
rest were immediately removed to camp. In the epidemics of 
1813 and 1814 no person in the house in which she lived was ill. 

Angela Bebraqua, Parody's mother, declared that Parody had 
not the epidemic in 1804, in 1810, in 1813, or in 1814. 



of Clothes from the Dygdenr 



257 



Mr. Amiel, however, tlie surgeon of tlie I'ith. Regiment, gave 
tke following evidence upon this subject : — " I know Mary 

Parody; she lived in 1810 close to Mr. Key's family, in the 
" South. Her mother paid great attention to the Rey family 
*^ during their illness, and the Parody family were consequently 
" removed with the Rey family and the other neighbours to 
" the Neutral Ground, by order of Dr. Pym. These families 
"returned to the same buildings after about 16 or 17 days; 

two people fell sick in those families after their return ; and 

the Rey family were again sent out, but the Parody family 
" was not sent out, as Mr. Ferrari, the owner of the house and 
" inspector of the district assured me, and I assured Dr. Pym, 
" that the Parody family had passed the fever in ISO^J." I 
have taken this evidence from my own notes, which are some- 
what more full than the minutes. 

I have gone into greater detail upon this evidence respecting 
Parody and Silcox than I should have thought necessary, 
because the cases were strongly relied upon at the Board, 
although the anachronism above pointed out at once overturns 
them ; independently of which, we have the evidence that 
Parody's disease in 1828 was not the epidemic fever, and the 
presumptive evidence to show that Parody had the epidemic 
fever in 1804. With regard to Silcox, she was the woman 
whose extraordinary seclusion was so pointedly noticed by 
the late Dr. Hennen and by Mr. Woodward, in his viva voce 
evidence. 

Another channel through which the epidemic was stated to 
have been imported from the Havannah is by means of the 
clothes of Teste, the health guard, which on his return from 
the " Dygden" were washed by his sisters, and, it is assumed, 
infected one of them with the Yellow Fever. This story was 
introduced by the Spanish practitioner Dias, who in a letter 
dated January 30th, addressed to the secretary, states that he 
has no doubt that Miss Teste's disease, for which he was called 
to attend her on the 24th August, and with which she had been 
attacked August 21st, was the Yellow Fever. Dias's letter 
upon this subject is worth perusal. 

Teste, the health guard, states that on his return from the 
" Dygden" his clothes were washed by his three sisters on the 
10th of August ; his sister Mary was taken ill on the 21st: 
" She was not ill of the epidemic fever, because I heard the 
" Spanish Dr. Dias, who attended her, tell the Spanish Com- 
" mission from Alge^iras, that it was a common bilious re- 
" mittent fever." Teste himself was ill of the epidemic from 
the 11th to the 26th of September, more than five weeks after 
he had quitted the " Dygden," and three weeks after the 
washing of the clothes which Teste had worn on board that 
vessel had, as it is said, infected his sister. Dias himself was 



258 



Evidence concerning the Washing 



tlien called, and said lie liad set Miss Teste down as suspected 
of labouring under Yellow Fever, whicli suspicion afterwards 
amounted to a certainty. He denies tliat lie made any ob- 
servation as to tbe nature of Miss Teste's disease to tbe Alge- 
giras Medical Commission, be " merely sliowed tbe patient, as 
*^ they bad eyes as well as I." 

Teste being recalled, repeated bis first statement, and Dias 
in like manner persisted in bis denial. Dr. Massias, one of tbe 
Alge^iras Commission, on a subsequent day, came over to 
Gibraltar, and declared tbat be saw Miss Teste witb Dr. Dias 
in September, and tbat on tbat occasion " Dr. Dias told me 

tbat sbe bad a simple affection of tbe stomacb, for wbicb be 
" was tben giving ber a watery infusion of bark." Dr. Gill- 
krest, 43rd Ligbt Infantry, added to tbis, tbat be was present 
wben on September 4tb all tbe civil medical practitioners were 
assembled in tbe Town Major's office, and were requested to 
give frankly, for tbe information of tbe Medical Commission, 
from Algeqiras, an account of tbe nature of tbe fevers tbey bad: 
had under their charge during the summer. ''^All declared- 

that up to tbat period no fever had been treated by them, 

except what they called estacionales, meaning fevers from 
" local causes, and at particular seasons of the year. I recollect 
" perfectly well that Dr. Dias was present on the above occa-> 
" sion. I know that he in particular made a declaration to tbat 

effect ; in fact, as he was the leading man, I took particular 
*' notice of him. He, as well as Dr. Mortera, stated tbe same 
" thing to me afterwards." I cannot but observe that tbis is 
not the only instance in which tbe evidence of Dias is con- 
tradicted. Evidence was tben given to support the testimony 
of Dias, by proving repeated unsolicited declarations by this 
health guard Teste, that be himself had brought the epidemic 
into Gibraltar from the " Dygden." It is only necessary to 
read this evidence, especially tbat of Picardo, to be convinced 
of its futility, bearing in mind tbe public office which Teste 
filled at tbe time. 

I shall shortly notice tbe absurd detail of Mr. Beneditto 
Cohen, who is described in tbe Minutes as a " public writer." 
This writer pronounces tbat bis daughter had tbe epidemic and 
caught it by watching and stirring some clothes which were 
being boiled ; and he gives as a diagnostic of the disease that 
wbicb appears to have escaped tbe professional men whose 
evidence was taken upon tbe medical topics that were inquired 
into. Having declared tbat bis daughter so fell ill, and that he 
himself fell ill immediately after, in order to bring their disease 
under tbe proper class, be describes a very simple symptom by 
which to detect its species, and (what is more important) he 
points out, witb the assistance of Cortes, an equally simple cure. 
After giving a long detail about a female, whom he describes 



of Clothes from the " Dygden'^ 



259 



as '* a favourite woman of ]\Ir. Horsey's," whose name is un- 
known, but wtio is said to have the nickname of Moma, who 
was a washerwoman, and had asked this public writer's 
daughter to watch and stir some boiling clothes for her during 
her absence : immediately after which Moma fell sick, then 
Miss Cohen, and lastly Cohen himself After informing us 
that the nameless Moma had told him that these clothes which 
herself had washed and his daughter had washed and stirred, 
had come from some ship from the HaA^annah. This witness 
proceeds thus : — 

Finding a taste of mutton in my mouth, and that my 
" daughter had the same taste of mutton in her mouth, the 
" second day after my daughter was taken ill, being the morning 
" I was taken ill myself, I sent to Mr. Cortes's shop and bought 
" two doses of salts, one for myself and one for my daughter, 
" thinking that this was the most proper medicine. Finding 
that this medicine, one ounce and a half to myself and one 
" ounce to my daughter, had no effect on either of us, both 
" getting worse, icith a taste of mutton in our mouths, the next 
" morning I called again at the same apothecary's shop, scarcely 
" able to walk, and with a burning fever. I found the doctor, 
" and got a vomit of hippo for myself and another for my 
daughter. He advised me not to take a vomit, or I should 
die directly, but to take a clyster. I was convalescent on 
September 3rd, after I had been ill from the Saturday night 
" till the Friday following." This man and his daughter were 
immediately afterwards sent with the other persons of his neigh- 
bourhood to the Neutral Ground. I have copied this part of 
his evidence from my own notes, because this public writer's 
grave reference to the taste of mutton has been omitted in the 
Minutes, and his whole relation upon this point, to be properly 
appreciated, should be taken together. And this man's evi- 
dence, with a declaration that the nameless Moma died during 
the epidemic, and was in the habit of washing ships' clothes, — 
which declaration is made by the same Mary Gait, whose pro- 
fession need not be adverted to ; — this is the evidence upon which 
I am seriously called upon to say that it is proved that such 
a person as the nameless Moma washed clothes from the 
Havannah, — that this washing infected her with Yellow Fever, 
— and that the watchino; and stirrincr tlie same clothes o-ave to 
Miss Cohen the Yellow Fever, and which disease she commu- 
nicated to her father. 

In failure of all these attempts to trace the epidemic to the 
Havannah, through the washerwomen Parody, Silcox, Teste, 
and the nameless Moma, one other effort to fix the fever upon 
the Dygden'' remains to be considered. This effort was made 
by Francisca Roca, who represents herself to have had a brother 
on board a ship from the Havannah, who had had the fever 



260 Evidence concerning the Washing of Clothes, Sfc. 

there. He brought clothes ashore, which she threw out of the 
bag, hut did not wash. Four or five days afterwards she replaced 
them in the bag and returned them to her brother, who took 
them away and embarked in another vessel. Thirteen or 
fourteen days after he went away I fell ill ; I never counted 
the days. I kept my bed four days." She does not know 
the month in which he arrived, nor the vessel he came in. She 
does not know where he now is, but thinks he is at sea. T. 
" was ill once with the epidemic, but no more." 

Mr. Charles Bellardo, the master of the last witness, tells 
nearly the same story, adding, that the ship in which Roca, the 
sailor, arrived was the " Dygden." The only difference between 
them is that, according to Mr. Bellardo, Francisca fell ill on 
the 20th of August, two (instead of 13 or 14) days after her 
brother's departure, and had " one day's fever, and two days 
" not well." His evidence then proceeds in these words : 
*^ When she took ill, at that time Dr. Mortera said it was a 
" liver complaint ; but some time after, when it loas spread 
''about that the ''Dygden'' had imported the fever, yir. Marcos 
" Superviele persuaded both Dr. Mortera and myself that he, 
" Dr. Mortera, had cured Francisca Roca of the Yellow Fever." 
Without meaning to insinuate aught against the persuasive 
powers of Mr. Marcos Superviele's eloquence, it must, at least, 
be admitted that, in the present instance, one-half of his 
audience was well disposed to be convinced by his arguments. 
Mr. Bellardo proceeds with admirable naivete : " When she 
" was sick again on the 28th of September, both Mr. Superviele 
" and Mr. Mortera, and myself, were disappointed about her 
" first sickness. Mr. Mortera attended her in both illnesses ; 
" this last time she was in bed six or seven days." 

It would be an inexcusable waste of time to pursue this 
further, and follow out the desperate attempts to show that 
some three weeks after this sailor had quitted Gibraltar, and 
when the epidemic was raging through the town, some children, 
who then caught the epidemic, must have contracted it from 
this man, because, amongst other reasons, they had been in his 
company and played with some tools three weeks before, when 
he was sawing some planks. 

This Roca is the man whose name, as I have already stated, 
does not appear in the official list, furnished by the Swedish 
Consul, of sailors left by the " Dygden" at Gibraltar. 

Here I leave the journals of washerwomen, and the tattle of 
their gossips, remarking this fatal objection to each washing- 
tub anecdote, however circumstantial, that not one of them goes 
hack so far as to precede, and therefore to account for, the alleged 
first case of the epidemic, namely, that of Salvador Fenic, who, 
as we are told, fell ill on the Wth of August, and upon whose 
single case, therefore, the proof of importation rests. And if 



BUI of Health of the " Dygden' omitted from the Proceedings. 261 



the attempt to connect tlie illness of Salvador Fenic with a 
foreign source be, as I liold it to be^ a complete failure, bow is 
the illness of tbe boy Caffiero to be accounted for ? And to 
what is to be ascribed tlie illness of Mr. Martin's child on 
August 16th, a case quite as early as that of Cafiiero^ and 
which has not been attempted to be traced to importation? 
not one of the washing-tub cases being anterior either to that 
of Mr. Martin's child or to that of Caffiero, both of which are 
unquestioned cases of the epidemic. 

I find nothing like satisfactory proof that a disease identical 
with the epidemic existed on board the " Dygden." On the 
contrary, while that vessel was lying in quarantine at Gibraltar 
rumours against her had been circulated, and, in consequence, 
an extraordinary quarantine had been imposed at Alicant upon 
vessels arriving from Gibraltar. This was known at Gibraltar 
at the end of July; was officially announced by the Lieut.- 
Governor to the late Dr. Hennen, who, in his letter of August 2nd, 
expressly states that he had minutely inspected the captain and 
crew of the ^* Dygden," whom he found in perfect health, adding, 
" I shall repeat my inspections before the expiration of their 
" quarantine, the 6th of the present month." This report was 
written, as it strikes me, under circumstances which entitle it 
to much consideration. This ship had been officially pointed 
out to him (as the medical officer of quarantine) as being 
strongly suspected. The responsibility of his office was thus 
brought fully before his eyes, and he had then no motive for 
making a false report of his inspection of the "Dygden's ' 
master and crew, because the epidemic had not at that period 
commenced. If he had observed any reasonable grounds for sus- 
picion, he had only to fall in with the rumour and recommend 
that none of the persons or susceptible articles on board should 
be permitted to land. The conduct and declarations, therefore, 
of Dr. Hennen, as a responsible public officer, under such cir- 
cumstances, when, if he erred at all, it would probably be on 
the side of over caution, I hold to be most material. 

The inability to make out that the epidemic was imported, 
notwithstanding the exertions which were made, under such 
favouring circumstances, for that purpose, I take to furnish a 
presumption that the disease was indigenous. I am aware that 
it is thought that the circumstances of the introduction of a 
disease are difficult of proof. I do not agree in this. I think, 
on the contrary, that if the stories of Villalunga and Caffiero 
had been consistent with truth, in the absence of countervailing 
evidence, their testimony would have been sufficient to esta- 
blish the position. 

It has been, upon insufficient evidence, assumed as a fact, 
notwithstanding the " Dygden's" bill of health (a very 



262 Influence of Locality exemplified in the \2th Regiment. 

important document wliicli, altKougli presented to tlie Board 
and ordered to be attaclied to the proceedings, is not there to 
be found),* that a disease identical with the epidemic existed 
at the Havannah when the " Dygden" sailed. It would^ how- 
ever, not be unreasonable to presume that at some period or 
other, between the years 1815 and 1827, both inclusive, the 
Yellow Fever existed in the latitudes appropriate to it. By a 
return laid before the Board, it appears that in those 13 years 
not fewer than 844 vessels arrived at Gibraltar from those 
latitudes, some having lost men, some having been sickly on 
the voyage without losing men, although none actually having 
patients on board labouring under Yellow Fever on their arrival 
at Gibraltar. It appears by the evidence of the Deputy 
Pratique Master that he does not recollect, during the 18 years 
he has held his office, one single instance of health guards 
being put on board, or of fumigation being applied to any ship 
from the West Indies before the "Dygden" (an admission 
which would seem to be perfectly disinterested on the part of 
the department to which this gentleman belongs), although he 
states that he thinks he has never seen the crews of vessels 
which have arrived from the West Indies in perfectly good 
health on arrival. In many cases all on board have borne a 
sickly appearance, while the precautionary measures adopted 
in those years were much less rigorous than those adopted in 
the case of the " Dygden," for that, subsequently to 1814, such 
vessels were allowed to bring cotton, which they now are not ; 
and he only recollects one instance (which could not have 
occurred between 1815 and 1827) in which the bedding and 
clothing of persons on board ships in which sickness had pre- 
vailed, during their voyage from the West Indies, had been 
immersed in sea water. He attributes the extraordinary mea- 
sures resorted to in the case of the "Dygden" to a knowledge 
of the rumours which had been spread on her arrival. Now, 
under the very liberal pratique regulations which obtained in 
the 13 years between 1814 and 1828, with regard to sickly 
vessels arriving from Yellow Fever countries, and considering 
the extensive intercourse between those countries and Gibraltar, 
in every season of each of those years, it strikes me as being 
impossible that a Yellow Fever epidemic should not have been 
imported during that long period, if it be importable. 

The facts stated by Lieut. -Colonel Bayley, the commanding 
officer, and by Mr. Amiel, the surgeon of the 12th Infantry, 
are, in my opinion, conclusive. That regiment, in the epidemic 
of 1828, presented a singularly good opportunity for trying 
some important questions. 

When the sickness had appeared in that corps the regiment 

* See Dr. Gillkrest's Report, Addenda (F.), pp. 214- 16. 



Also in the 42nd and 43rd Regiments. 



263 



was removed to the Neutral Ground from its quarters in the 
town^ one range of which adjoined the district first infected. 
This removal took place on September 5th, at which time the 
regiment had sent five patients into the Regimental Hospital. 
This corps was exonerated from its share of military duty in 
the garrison, a part of which had been the furnishing guards 
in and about the infected district. No new case of fever 
occurred in the corps while it remained on the N eutral Ground, 
although several orderly men attached to the diiferent depart- 
ments in town, who had not been removed with their regiment 
to the Neutral Ground, caught the disease. Lieut. -Colonel 
Bayley says, On the 23rd September we commenced taking 
" the town duties again, and on the 25th men began to go 
" rapidly into hospital, from which time this continued until 
" the termination of the epidemic :" 282 women and children 
of that regiment, who continued on the Neutral Ground from 
the 5th September until the termination of the epidemic, 
wholly escaped the disease ; one woman only, who having re- 
entered the town and remained in it a day or two, caught the 
fever, and she died. Several of these women slept on the 
Neutral Ground in the same beds with their husbands, while 
these last were labouring under the epidemic which they had 
contracted after the regiment had resumed its share of duty 
within the garrison, and with their children continued to use 
the same bedding after the husbands were removed to hospital ; 
but in no instance was the disease contracted by the wife or 
child of the soldier, who had thus caught the fever during his 
temporary absence from his tent on the Neutral Ground, while 
mounting guard in the garrison. 

Four orderly men, who attended several fever patients in 
the hospital sheds on the glacis in front of the northern 
extremity of the Rock, and above the Neutral Ground, escaped 
from any attack ; but not one of the orderly men employed 
during October in the hospital on the Rock escaped, excepting 
one of the watermen. 

The fever spread among the population in that part of the 
Rock, called the South," two or three weeks later than in the 
town; from September 2nd to October 1st, several cases of the 
epidemic were admitted into the 1 2th Regimental Hospital at 
" the South," three of which died with the Black Vomit ; but 
the disease never attacked any of the other patients, more than 
20 in number, treated in that hospital at the time for other 
complaints, nor any of the orderly men who had incessant 
and unreserved intercourse with the fever patients, were fre- 
quently in contact with the dying, and slept in the same wards. 

It was only on the 25th September when the disease had 
spread to " the South," and the epidemic influence had extended 
through the district where the hospital is situated, that the 



264 



Ohjections raised against Sporadic cases. 



cook, who never had occasion to approach the sick, contracted the 
disease ; and in October, wlien the atmospheric causes had 
acquired more intensity, the hospital serjeant and 12 orderly 
men sent into the hospital at the South, from the camp on the 
Neutral Ground, were taken ill, but a few days after entering 
the precincts of the hospital, and several of them died. 

These are facts which, proved, as they are, by the unim- 
peachable testimony of the lieutenant-colonel and surgeon of 
the 12th Regiment, in my opinion irresistibly force upon the 
mind the conclusion drawn by those gentlemen, that the origin 
and spread of the disease were local, being confined within the 
limits of the vitiated atmosphere of the place. 

If anything could add to the force of such evidence it would 
be that which followed : 

Upon the removal of the 12tli from the Rock to the Neutral 
Ground, the duties theretofore allotted to it were taken by the 
43rd Light Infantry ; which corps, however, be it remarked, did 
not occupy the barracks which had been vacated by the 1 2th. 

" The two first men of my regiment," says Lieut.- Colonel 
Haverfield, commanding 43rd Light Infantry, " were taken ill 
''on the 10th September, a third on the 11th; after which 

there were admissions almost every day into hospital until 

the epidemic ceased." Those guards from which the 12th 
had been relieved were furnished exclusively by the 43rd until 
September 17th, when this regiment also marched into camp 
on the Neutral Ground, and were succeeded in the whole of 
these duties by the 42nd Royal Highlanders, the first case in 
which regiment occurred on that day, as appears by the evi- 
dence of the commanding officer. Major Middleton ; and when 
the 42nd Royal Highlanders marched out into camp on the 
22nd September, 18 cases of fever had occurred in it. On the 
23rd September the 12th Regiment resumed its share of the 
town duties ; from that time these duties were taken by the 
three regiments in common, and we have already seen by the 
evidence of Lieut. -Colonel Bayley, that from that day the fever, 
which had ceased in the r2th for 18 days, re-appeared, and con- 
tinued to rage till the termination of the epidemic. 

It is impossible to imagine a chain of circumstantial evidence 
more perfect in all its parts than this, or facts established by 
witnesses more disinterested or of higher character. 

Much conflicting evidence was given upon a question of fact, 
namely, the occurrence, in seasons when the epidemic did not 
prevail, of scattered cases of the same disease. This question 
of fact became practically a question of science, because the 
medical members of the Board disputed the identity of these 
occasional scattered (or, in medical phraseology, sporadic) cases 
with the epidemic disease. 



Mr. AmieVs Evidence on Sporadics. 



265 



It is an extremely delicate matter for a man, imskilled in 
tlie art of medicine^, to determine between tlie conflicting opi- 
nions of medical men and to decide upon the facts adduced 
by them to support their theories. I approach this part of the 
subject, therefore, with much diffidence ; and the more so, be- 
cause a line of examination, which I felt myself unable to 
follow, was pursued in regard to some few of the medical 
"witnesses, which was excellently calculated to try their science 
and skill, partaking, as it did, in a great degree of the character 
of a severe academical examination. This line of examination 
having been pursued in some instances, I regret that there was no 
medical member on the Commission who held the opinion that 
the epidemic was indigenous, so that the same mode of treat- 
ment might have been applied to witnesses on both sides, that all 
the facts adduced should have been subjected to the same 
anatomical dissection, and that the opinions of both parties 
should have undergone the same public medical scrutiny ; that 
Doctors Ardevol, Dias, Zela, Cortes, Bobadilla, &c., should 
have had the same opportunity of vindicating their professional 
opinions, under a skilful medical cross-examination, which was 
afforded to Mr. Wilson, Mr. Fraser, Mr. Amiel, and Dr. Chervin. 

Notwithstanding, however, that this course of professional 
examination was confined to one class of the medical witnesses 
only, so that on a point where science and skill form the only 
grounds of confidence, the science and skill of every professional 
witness were not subjected to the same severe test, and cannot, 
therefore, be equally appreciated, I must deal with the testi- 
mony as I find it, remembering that my judgment is to be 
guided by the weight of the evidence, and not by the number 
of the witnesses. 

Several medical gentlemen depose to having seen cases 
identical with the epidemic disease of Gibraltar, in seasons not 
epidemic. 

Mr. Amiel, surgeon of the 12th Regiment, has constantly 
resided in Gibraltar from the year 1810 ; and it appears that 
his experience of the Gibraltar epidemic is by no means incon- 
siderable, for in 1810 he treated about 12 patients ; in the 
epidemic of 1813, about 200 ; in that of 1814, about 200 ; and 
in that of 1828, about 260. This witness was asked, — 

From the beginning of 1816 did you meet with any cases 

of fever here which you consider to have been identical 
" with the late epidemic?" — " I have met with some cases of 
" fever here which I consider perfectly identical with the late 
" epidemic." 

" How many sporadic cases of this disease have you met 
^' with ? in what years ? and in what months of the year during 
the period alluded to ?" — " In my opinion I have seen five 
distinctly marked cases during that period ; one in the month 

T 



266 



Drs, Browne^ Gillice, GiUkrest, and Dix, 



of August, 1818; two in Septem"ber, 1822; and two in 
November, 1825, one of which is given in my report for that yeary 
" Will you be good enough to describe the symptoms by 
which you consider that these cases were distinctly marked 
cases of a disease identical with the late epidemic ?" — They 

^' were attended with very high fever, great irritability of the 
stomach, yellowness of the skin, black dejections, and in two 

" of these cases the black vomit. The two with the black 
vomit died, and in the three who recovered there were passive 
haemorrhages." 

I have extracted these questions and answers from my own 
notes, which are more full than the minutes of the Board, in 
which the words underscored are omitted. 

The witness then underwent a medical examination upon 
the nature and properties of fevers, upon which it would be 
presumptuous in me to offer any further remark than that the 
impression produced by it upon my mind was, that the witness 
was a man of remarkably clear head and acute understanding, 
possessing (as indeed was to be expected from his great expe- 
rience) intimate knowledge of his subject. 

No doubt having been suggested as to the skill or veracity 
of Mr. Amiel, and no attempt, not even an insinuation, having 
been made to impugn or question his evidence concerning these 
five cases, I cannot but receive that evidence as conclusive. 

Dr. Browne, assistant surgeon of the 23rd Royal Welsh 
Fusiliers, stated that in May 1826 he saw two cases of fever in 
the Civil Hospital, which he considers to have been identical 
with the more severe cases of the late epidemic ; that these were 
the cases of two Jews, the survivor of whom enjoyed during 
the late epidemic the usual immunity from a second attack. 

Mr. Gillice, assistant surgeon of the 12th Regiment, gives 
evidence to the same effect as to the cases of the two Jews ; 
and he adds another case, that of Lieutenant Ottly, of the 
23rd Regiment, who was attended by Dr. Smith, a gentleman 
who was absent from Gibraltar at the time the Board ^ was 
sitting. 

Dr. Gillkrest, surgeon of the 43rd Light Infantry, speaks to 
two sporadic cases in the year 1824; one that of private John 
Pierson, of that corps, whom he attended until, in the course of 
such attendance, he himself was taken ill ; his own case is the 
second. Both of these cases he identifies with the epidemic. 
He was attended by Dr. Arejula, physician to the king of 
Spain, who considered this to be a sporadic case of the Yellow 
Fever of Andalusia. 

Stafi'-surgeon Dix only saw 10 or 12 cases during the epi- 
demic, he having been absent, and not having returned to 
Gibraltar until its close. He states that those cases appeared 
to him to differ in no respect from the bad Sporadic Yellow 



3Iess?'s. Fraser and Wilson, on Spoi^adics. 267 



Fever cases wliicli lie liad witnessed annually during his resi- 
dence on tlie Rock from 1820 to 1826 ; two or three times 
between 1820 and 1826 he saw at the Civil Hospital cases^ 
attended with the black vomit. 

These are the only military medical officers who speak to 
the occurrence of sporadic cases of the disease in seasons not 
epidemic. With regard to this class of witnesses, it is to be 
remarked that the smallness of their number, and the limited 
period of time which most of them speak to, are probably 
attributable to the frequent changes of station which charac- 
terise the military service, 

Messrs. Fraser and Wilson, the medical officers attached to 
the Civil Hospital, and both having extensive private practice, 
deposed to their having annually witnessed cases of fever identical 
with the epidemic. Each of these gentlemen underwent a long 
controversial cross-examination touching the symptoms, charac- 
ters, and qualities of fevers, continued, remittent, and inter- 
mittent, their causes and effects, and typhus icteroides, and the 
typhus of Ireland, and agues and malaria, and sundry specu- 
lative opinions touching all these matters, of which disputation 
T am imable fiiHy to appreciate the merits, excepting in so far 
as it shows that the two gentlemen of the faculty who were 
under examination are men of considerable ability, who had 
(as was their especial duty) closely studied and investigated 
the fevers of Gibraltar, who have professionally been much 
engaged in the treatment of those fevers in the public hospital 
of which they have the medical charge, and whose opinions, 
consequently, are entitled to the most respectful attention. 

Mr. Wilson declares that he treated about 200 cases of the 
late epidemic ; that he had, between the years 1811 and 1813, 
seen the same disease {i.e., the Black Vomit Fever of the West 
Indies) in Jamaica, in Carthagena (South America), and in the 
Havannah; and that he had in the Civil Hospital at Gibraltar, 
generally every year, from 1815 to 1828, met with cases of the 
Black Vomit Fever of the West Indies, accompanied by the 
same symptoms, and terminating in some patients by death 
under the same circumstances as cases of the late epidemic. 
He added that he had carried from the Wcn( Indies to England 
a specimen of the Black Vomit, and speaks positively to the 
identity, with it, of the Black Vomit which he had observed in 
sporadic cases at Gibraltar between 1 81 5 and 1828. 

Mr. Fraser stated that he had treated about 200 cases of the 
late epidemic, and that he had seen many, perhaps 500 or 
600 more ; that he had been surgeon to the Civil Hospital 
about five years, which situation necessarily forced him to pay 
attention to the general health of the place, and that he had 
directed his attention particularly to the subject of fever ; that 
during the five years of his residence, and previous to August 



268 Fraser and Wilson on Sporadic Cases in Hospital. 

1828 (wKen tKe epidemic broke out) he saw between 40 and 
50 cases which he is inclined to identify with the epidemic ; 
that he saw no difference in symptoms between these sporadic 
and the epidemic cases, even those with the black vomit ; that 
the mortality in these sporadic cases was great, perhaps I in 3J 
or 4 ; that he has no doubt as to occurrence of black vomit in 
some of these cases similar to the black vomit observed in the 
epidemic, nor has he been able to distinguish any difference in 
the post-mortem appearances observed on the dissections of 
several of the bodies of those who died previous to and of those 
who died during the epidemic : he added that an analysis of 
the black vomit had been made in the Civil Hospital long 
before the breaking out of the epidemic. 

The whole of Mr. Fraser's and Mr. Wilson's examinations, 
on the different occasions when they appeared before the Board, 
are extremely material, nor can they be abridged without ren- 
dering them obscure. 

Mr. Fraser, in support of his opinion that the disease was 
indigenous, presented to the Board a list of 39 cases of Yellow 
Fever, recorded in the case books of the Civil Hospital as 
having occurred in years when no epidemic prevailed. To 
counteract this, evidence was adduced to show that some few 
of the patients in these sporadic cases had suffered the fever in 
some epidemic season, whence it was intended that we should 
infer that the cases presented by Mr. Fraser must have been 
cases of some other disease. 

Had this been satisfactorily proved, the credit of the case- 
books and the testimony of Messrs. Fraser, Wilson, Dix, Browne, 
and Gillice, might have been in some measure shaken, inas- 
much as it had been decided by the Report of a Medical Com- 
mission that " one attack of Yellow Fever preserves the individual 

from a second." 

In opposition, then, to Mr. Fraser's list, the hospital patients 
themselves in some instances came to depose to their having had 
the Yellow Fever in some epidemic year ; and in other instances, 
when the patient himself was dead, or not to be found, his 
relatives, or some one who said he knew him, gave evidence to 
the same effect. No medical evidence whatever was produced ; 
but the bare assertion of a bricklayer, a labourer, or a journeyman 
butcher (this was the occupation of Sabah, as deposed by him- 
self, though it does not appear upon the minutes), was given as 
evidence capable of outweighing the professional opinions of the 
medical attendants of the hospital supported by the entries in 
the case-books. On a professional point such impeaching evidence 
would be worthless under any circumstances ; but on this par- 
ticular occasion the impropriety of receiving it as conclusive is 
aggravated by a remarkable instance of inconsistency. 

The Report of the Commission, which is made the test of the 



Cases reported in 1 827 hy Dr. Hennen. 269 



hospital cases, contains the following sentence : — " Four physi- 
" cians had attended in 1828 some patients who said that they 
" had had the Yellow Fever in one or other of the former 
" epidemics ; but as the symptoms of the first attacks could not 
" be stated, the Board could not take these cases into condidera- 
" tion." Now as it is certain that no symptoms were stated to 
the Board by the journeyman butcher or his colleagues in their 
attempt to shake the credit of the hospital cases^ it would seem 
to be particularly unfair to admit, as sufficient to overturn these 
cases, such evidence as would have been rejected by the Com- 
mission whose Report is made the foundation of this line of 
inquiry. 

The same evidence, to establish the same fact, cannot be good 
in one place, and had in another. If good against Mr. Fraser's 
cases, the Report of the Commission, which excluded such evi- 
dence as bad, must of course be itself worthless, as being founded 
on insufficient testimony^ and then the fact found by that Report 
cannot be assumed as a test to try any question whatever ; but 
if such evidence be had^ and the Medical Commission were right 
in rejecting the loose assertions of ignorant men, unsupported by 
any specification of symptoms, or by the testimony of a medical 
attendant, then the evidence of Sabah and the rest must be 
rejected by us, and the genuineness of the civil hospital sporadic 
cases stands unimpeached.* 

A long medical discussion took place upon some three or four 
cases quoted by the late Dr. Hennen, in his Annual Report for 
1827 ; and it w^as disputed whether the patients named therein 
had the Yellow Fever, and whether they contracted their disease 
in Gibraltar or in the adjoining country ^ upon which I am 
incompetent to form an opinion, nor does it appear to me to be 
very directly material to the question as to the origin of the 
epidemic ; and I accordingly dismiss these cases altogether from 
further consideration. 

Divers medical men, chiefly the civil practitioners, deposed 
to their not having met with any sporadic cases in the course 
of their practice : this evidence might well have been spared^ 
because it amounts to nothing ; for witnesses are called to declare 
what they do know, not what they do not know ; what they have 
seen, and not what they have not seen. 

The occurrence of sporadic cases of this disease in years not 
epidemic is confirmed by the general course of events at the 
beginning of the late epidemic. The alleged first cases (those of 
Fenic's children) struck their medical attendant with no surprise 
or alarm : if these cases had presented appearances which he 
had not been accustomed occasionally to see — even what is 
described as " the fatal symptom of black vomit " — he wou]d 

♦ Vide the Certificate, Dr. Gillkrest's Eeport, p. 155 — of the existence of which 
1 was not aware when this paper was written. T. J. H., 7th March, 1851. 



270 Opinions of Dr. Chervin and others on local Origin. 

naturally have been astonished and alarmed at the occurrence of 
a disease foreign to his practice. In the earliest cases, no medical 
man who had not witnessed an epidemic denounced the appear- 
ance of an unknown disease unusually rapid in its progress, or 
marked by any unusual symptoms, nor did any medical man 
who had witnessed an epidemic suddenly proclaim to the com- 
munity his having for the first time since the year 1814 seen a 
case identical with that disease, and warn the public of the recur- 
rence of a malady from which they had been for fourteen years 
exempt. On the contrary, judging of men's real opinions by 
the safest criterion, — their own acts, — I find that the circum- 
stance which caused experienced as well as inexperienced me- 
dical men to announce the presence of the Yellow Fever epidemic 
was not the occurrence of one, of two, or of more cases, but the 
gradually increasing number of cases of the same disease, from 
day to day, in the same district of the town ; — that it was not by 
anything unusual in the nature of the disease, but by something 
unusual in the number of cases, that the advent of a Yellow Fever 
epidemic was ascertained. 

Several medical witnesses were examined as to their opinion 
of the origin of the epidemic. Of these the witness who has had 
the most extensive experience of the disease is Dr. Chervin, one 
of the members of the French Medical Commission. 

This gentleman appears to have made the Yellow Fever his 
especial study, and to have prosecuted his inquiries in every 
part of the world where it is to be found. He had witnessed 
the disease in Guadaloupe ; in the city of San Domingo, and in 
port au Prince, in the same island ; in Kingston, Up Park Camp, 
and Port E-oyal, Jamaica ; in St. Jago de Cuba ; in the city of 
Havannah ; in New Orleans ; in Savanna ; in New York ; in 
Martinique ; in Barbados ; in Demerara ; in Barcelona ; and in 
Gibraltar during the last epidemic ; and he had personally in- 
vestigated the localities of several towns in the south of Spain in 
which Yellow Fever epidemics had existed; and of which he 
narrates some very remarkable circumstances. He pronounces 
a very decided opinion, supported by reasoning, that the epi- 
demic originated in Gibraltar. I may here remark, that, in the 
course of his evidence as given in the minutes, there is an 
omission which strikes me to be of some moment. In his answer 
to Question 14, Dr. Chervin stated that he had dissected subjects 
that had died of remittent fevers, " and in those subjects I have 
''found the same appearances as in Yellow Fever.'" These words 
I supply from my own notes. 

Mr. Dow, staff surgeon, who had witnessed the epidemic of 
1813 in Gibraltar, and who had seen the same epidemic disease 
in the West Indies, is of the same opinion, that the disease is 
indigenous. 



Opinions of Spanish Practitiomn 



271 



Dr. Gillkrest, surgeon of the 43rd Light Infantry^ declared the 
same opinion. 

1 forbear to enlarge upon the long and argumentative evidences 
of Mr. Wilson, (who had resided in Gibraltar from 1^15, and 
who had previously witnessed the same disease in Jamaica, in 
South America, and at the Havannah,) of Mr. Fraser, and of 
Mr. Amiel, who had witnessed all the epidemics of Gibraltar 
from the year 1810; all of whom decidedly attribute the epi- 
demic to local causes. 

Mr. Dix, staff surgeon, also attributes the origin of the epi- 
demic to Malaria. 

A very learned anatomical dissertation was addressed to the 
Board by Dr. Louis, one of the French Medical Commission ; 
ill the course of which he pointed out the anatomical ap- 
pearances observed on the dissection of subjects that had died 
of fevers in Paris ; he also described the appearances of 
subjects which he had dissected at Gibraltar, and which had 
died of the epidemic Yellow Fever. Dr. Louis's experience, 
however extensive in regard to the number of subjects, appears 
to have been confined to Paris ; and, indeed, he candidly ac- 
knowledged that, not having visited any hot climates, he was 
practically unacquainted with the diseases incident to them. 

Dr. Trousseau, the third member of the French Medical 
Commission, gives evidence much to the same effect as Dr. 
Louis. His experience had been confined to France. 

In the course of the evidence of these two gentlemen, which 
was given with every appearance of skill as well as of truth, 
neither of them gave any opinion as to the origin of the disease ; 
and however valuable their anatomical observations may be, in 
a professional point of view ; so far as the inquiries of the Board 
ivere concerned, their evidence appeared to me to amount only 
to this — ^that they had never seen the Yellow Fever in France, 
and that they had seen it at Gibraltar. 

Of the other medical men, several declined to commit them- 
selves to any positive opinion. 

Many, indeed, and these chiefly the foreign civil practitioners 
of Gibraltar, give very decided opinions that the disease was im- 
ported. Without wishing to deal illiberally towards the foreign 
practitioners on the Bock, I cannot but observe that they are 
persons whose information and habits are not such as to entitle 
their opinions and assertions to that respectful consideration which 
the testimony of scientific men, upon scientific subjects, ought to 
command. The extreme hardihood with which assertions are 
made by this class of witnesses, who cannot possibly know their 
truth, is instanced in the case of Dr. Zela, who having been 
asked, " Is this opinion founded upon ohservations made hy 
" yourself and, if so, state them ?" he replied, " it is so founded," 
and then proceeded to narrate the circumstances ; he was then 



272 



Evidence in support of Local Causes. 



asked, whether these circumstances had fallen under his own 

personal observation ? whether he had derived them from books 

or heard them from other persons ? " he then declares " the 
" circumstances I have mentioned are stated in medical disser- 
tations on the disease." Of a like character is the account of the 
propagation of the Yellow Fever on board a smuggling vessel, 
given by Dr. Cortes, the owner of that vessel — an account upon 
the face of it extremely improbable, which he could not know 
to be true, and which he could only have derived by hearsay 
from persons engaged in an occupation which is certainly not 
characterized by a scrupulous adherence to truth. 

Such also is the evidence of Dr. Ardevol, who describes him- 
self as having practised "publicly and privately" six years and a 
half, who states, " I consider this disease as contagious ; not only 
" am I of opinion that this disease can be transported from one 

place to another, but in Spain it is known as an historical fact, 
" that this disease has been transported on horsehach from one 
*^ village to another. In the history of the epidemic of Los 

Barrios, you will find the name of the cavalry soldier who 

brought the disease from Cadiz to that town." 

Of a similarly vague and inconclusive character are the evi- 
dence and reasoning of the other witnesses of this class such as Dr. 
Martinez and the rest, to enter upon an analysis of which would 
be a mere waste of time. I have thought it just to make these 
remarks because these witnesses were not subjected to any pro- 
fessional cross-examination, as was the case with the medical 
witnesses on the opposite side of the question. 

That the drains of Gibraltar emitted most foul exhalations is 
proved by evidence perfectly incontestable. I refer to the tes- 
timony given not merely by the medical gentlemen, but by Mr. 
Woodward, surveyor of revenue buildings, by Lieut.- Colonel 
Bayley, by Major Middleton, by Colonel Pearson, by Captain 
Crawfurd, by Quarter-Master O' Grady, and by others ; that 
these exhalations were such as not only to pervade most houses, 
but universally to corrupt the atmosphere, is proved by Major- 
General Pilkington, the Commanding Royal Engineer. 

That the population was redundant, and that the poorer 
classes were crowded together in dirty ill-ventilated abodes, is 
shown by the letters of the late Dr. Hennen (who expressly 
pointed to these on 29th August 1828, speaking of No. 24 
District, as sources of disease), and by the testimony of Mr. 
White, collector of Her Majesty's revenues, of Mr. Woodward, 
of Colonel Pearson, &c. 

That the poverty and distress of the lower orders had been 
progressively increasing up to the commencement of the epi- 
demic is proved by the evidence of Mr. White and of Mr. 
Woodward, which is corroborated by General Pilkington's 
declaration that the demand for labour had decreased, while 



Review of the Evidence. 



273 



it is proved tliat water is so scarce as to be retailed as an article 
of purchase by the keg. 

Reviewing the whole of the evidence^ then^, I find that the 
asserted importation of the disease rests chiefly upon the scien- 
tific opinions of the Spanish practitioners, and that the facts to 
support it come from the mouths of washerwomen^ cigar-makers, 
and females of the same class as Mary Gait and Mary Parody; 
while the proof that the epidemic had its origin in Gibraltar 
rests upon the opinion of Dr. Chervin, who has probably 
seen more of the disease than any other man in existence, of 
the surgeons of the public hospital, whose duties led them to 
an intimate knowledge of the diseases of the climate and the 
place, and of the English medical officers ; and that the facts to 
support this doctrine are proved by the commanding and other 
officers of regiments, by the chief engineer, and by several 
officers of the civil service, whose characters and station in 
society are guarantees for the truth of their assertions. 

London, 9t7i Nov. 1829. (Signed) T. Jones Howell. 



Supplementary Note. 

On a re-perusal of the foregoing Eeport, I see no reason to doubt the soundness 
of the conclusions which a very careful and minute analysis of the evidence forced 
upon my mind ; and my conviction remains unshaken, that the testimony of the 
child CaflBero, and of the other witnesses who were associated with him in the 
bungling endeavour to prove such a case as would establish the doctrine that yellow 
fever is contagious, and that the Gibraltar epidemic was an imported and not an 
indigenous disease, was not only false but suborned — (Ante, p. 250.) 

It was my misfortune to differ from the medical members of the Board of Inquiry, 
viz., Dr. Pym, superintendent-general of quarantine, Dr. Broadfoot, medical officer 
of quarantine at Gibraltar, and Staff-surgeon Barry ; but not having subsequently 
lost sight of questions to which my attention was on that occasion called for the 
first time, it has been some consolation to me to observe, that opinions, which 
appeared to me to be as true as they were then unpopular with persons in authority, 
have been steadily advancing with advancing knowledge ; that the doctrines upon 
which the quarantine system was founded are becoming gradually exploded, and 
^dt the attention of mankind is now with greater wisdom directed to the extir- 
V pation of those inbred causes of pestilence which grew and flourished under the 
/ mistaken policy that inculcated the reliance on quarantine and lazarettos as safe- 
guards against the invasion of epidemic diseases.* 

The coincidence is remarkable that those countries, such as Spain, of which the 
commercial policy is based on high duties, prohibitions, and monopolies, and in 
which, consequently, smuggling and bribery are most active, are also those in which 
the preservation of the public health is based on the doctrine of contagion, and on 
the infallibility of quarantine. 

But whatever efficacy may be attributed to the restrictions of quarantine as they 
affect the undisguised intercourse of legitimate commerce, it is clear that they apply 
no remedy to the clandestine operations of the smuggler, while it is equally evident 
that the more you appear to make your quarantine restrictions effectual by multi- 
plying their number and increasing their stringency, the more do you in reality 
encourage the contraband intercourse of the smuggler, who, by bribery, fraud, or 
force, sets all your restrictions at naught. 

The intercourse which is constantly kept up by the overland route between Europe 
and Asia through Cairo and Alexandria would seem to present favourable opportu- 
nities for disseminating the plague, if that be a disease capable of transit by contagion. 
March 7, 1851. T. Jones Howell. 

* " And he who were pleasantly disposed could not well avoid to liken it to the exploit of that 
gallant man who thought to pound up the crows by shutting his park gate." — Miltcn's Areopagitxca. 



274 Reply of Col. Chapman to the Secretary of State. 



JiXTRACTS from Official Correspondence relative to the 
Proceedings of the Board of Inquiry as to the Origin of 
the Yellow Fever Epidemic at Gibraltar in 1828. 

After the proceedings of the Board had terminated to 
-which each member had appended his opinion,* a detailed 
report was addressed by Dr. Pym to Sir George Don, and 
transmitted ^by him with those opinions for the information of 
Secretary Sir George Murray. Subsequently the Minutes of 
the Board were also forwarded, on the receipt of which, the 
Secretary of State addressed a Despatch to the Governor of 
Gibraltar, dated 2 July 1829, from which the following is an 
extract : — • 

" It is with regret I find that the question as to the origin of 
the fever, which for all immediate purposes of Government I 
was most anxious to have thoroughly investigated, and cleared 
from doubt, remains unsolved; for, placing out of view the 
qualified opinion of Dr. Broadfoot, the vote of the Town Major, 
and the grounds upon which the Captain of the Port declined 
giving any opinion,! I observe that, while Drs. Pym and Barry 
have, on the one hand, very decidedly given their opinion, and 
supported it by reasoning which is entitled to the most serious 
attention, that the fever was imported ; two other members of 
the Board have in an equally decided manner, denied that, in 
their opinion, any proof was produced to warrant the belief that 
the fever was imported. And as much stress has been laid by 
one of these members, Colonel Chapman, upon the description of 
evidence which was brought forward, and the manner in which 
it was given, 1 think it important that he should furnish me with 
an explanation of the reasons which he had for thus expressing 
an opinion w^hich goes to discredit the whole proceedings of the 
Board," 

In reply to this request of Sir George Murray, Colonel 
Chapman % wrote to Sir George Don, a letter dated Gibraltar, 
9th August 1829, which contained the following passages: — 

" Generally speaking, the witnesses brought forward in 
support of the hypothesisj that the late epidemic disease was 
imported, were of the lowest class ; they had all^ as I under- 
stood, undergone private examinations, which were but in a few 
instances submitted to the knowledge of the Board ; and much 
of this carries strong marks of previous preparation for the 

* See Appendix, No. I., page 161. f See Mr. Sweetland's opinion, p. 214. 
X Lieut.-General Sir S. R. Chapman, C.B., K.C.H., late Governor of Bermuda, 
and since deceased. 



Comments of Sir G. Murray on Defects in the Minutes. 275 



pubKc examination. * * * j i^g^yg alluded to private ex- 
aminations * * * 'yix. Howell, the Judge, and Mr. Sweet- 
land, the Captain of the Port, as well as myself, did, on several 
occasions, express their disapprobation of this practice : the 
latter, I well remember, frequently so ; and when his objections 
were overruled, he made a motion, — which was also lost, — that 
all information touching the matter at issue which should be 
collected by any member of the Board, should also be com- 
municated to the Board previously to the examination of the 
witnesses on it, in order to the proper management of such 
information, and to put all the members of the Board on an 
equality. That private examinations were taken by some of the 
members of the Board is certain ; that they had much influence 
on the minds of those who have either taken or received them, 
is scarcely less so ; and I am by no means free from doubt, that 
such had some influence in the composition of the report [by 
Dr. Pym] of the proceedings, spoken of in Sir George Murray's 
Despatch. It was on this ground that I, and probably the other 
members of the Board, — forming the majority on that occasion, — 
objected to the production of it ; it was set aside ; forms no part 
of the proceedings ; and I am ignorant of its eontents." 

On the 18th November 1829, Sir George Murray addressed 
to Sir George Don a despatch, requiring to be furnished with no 
less than about 24 documents referred to in various parts of the 
Minutes of the Board of Inquiry, but which had been altogether 
omitted on the face of them ; and amongst others, " that which is 
most highly material, the Bill of Health of the Swedish ship 
' Dygden.' " 

This despatch contains the following description of the state 
in which these Minutes were presented : — 

" The communications and evidence upon the same subject 
are so widely detached, and with no note of reference from one 
to the other, that it is all but impossible to pursue connectedly 
any one question agitated on the proceedings. * * * Very 
many errors purely clerical, appear on the face of the Minutes ; 
but some are such as materially to alter the effect of the testi- 
mony." 



[ 276 ] 



Appendix No. III. 



EEMARKS ON WEST INDIAN FEVER, &c. 
By Dr. A. Browne. 



London, ^rd January 1851. 

My Lords and Gentlemen, 

In reply to the request transmitted to me from your 
Honourable Board, I beg to say tbat any observations of mine 
on the subject of Yellow Fever, which may be deemed useful, 
are entirely at the service of the public ; and I now venture to 
submit for your consideration, the following notes on fever in the 
West Indies and coast of Africa, founded chiefly on facts and 
observations contained in the statistical reports for the army from 
1817 to 1836, and for the navy from 1837 to 1843. 



The mortality from fever among the white troops serving in 
Jamaica, on the average of 20 years, has been in the following 
proportions to 1,000 of mean strength, at the undermentioned 
stations, viz. : — 

Montego Bay 
Spanish Town 



Port Antonio 
Up Park Camp 
Port Royal . 
Falmouth 
Stoney Hill . 
Lucea 

Fort Augusta 
Maroon Town 

Vide Table LX 



150-7 
141 -1 
126^0 
121-0 
93-9 
80-0 
70-5 
63-2 
55-5 
15-3 



p. 70. 



N.B. — The mortality from fever among the black troops, 
on an average, has been less than 1 per cent., and 
may be disregarded, as the strength of these troops 
at the several stations is not known. 

At some of the small stations, temporarily occupied during 
disturbed periods, the mortality has far exceeded that at any of 



Mortality from Fever in Windward S^^ Leeicard Commands, 277 



the permanent posts here given ; but as the time they were held 
was short, and the force small, they are not entered here. — Vide 
Report, p. 69. 

Table of Fevers for Jamaica, p. 46, Report. 





Admissions, 


Deaths. 


Proportion of 

Deaths to 
Admissions. 




6,090 
33,393 
1,971 
20 
448 


37 
5,114 

86 
15 
1 


1 in 165 
1 in 8 
1 in 23 
1 in 1^ 
1 in 443 


Total 


46,922 


5,253 


1 in 9 


Annual rates per 1000 of Mean Strength 


910 


101-9 





Average Strength 
, , Admissions 
, , Deaths 



2,573 
4,6721 
313i 



Total Strength in 20 years . . 
Ratio of all Admissions per 1000 . 
,, Deaths per 1000 . . 



from all Diseases. 

. . . 51,567 
. . . 1,812 
. ; . 121*3 



Note. — The 20 cases of Yellow Fever in this Table occurred in a detachment at 
Lacovia, on the Black River, a post about 12 miles from the sea, in 1834, when no 
epidemic Yellow Fever existed in any other part of Jamaica: 15 of those patients 
died in Fort Augusta; nevertheless, the deaths from all causes, at the latter station, 
were in that year under the annual average from fever alone, — Vide Report, 
pp. 47 and 54. 

Fevers, " though only in a small degree more prevalent than 
in the Windward and Leeward command," are "nearly thrice as 
productive of mortality /in consequence of about three-fourths of 
the cases being of a remittent type, which is extremely fatal ; 
whereas, in the other command, little more than a fourth of the 
cases are of that description." The mortality from the remittent 
type, however, has been 1 in 8 in both commands on the average 
of the whole :20 years ; this type is therefore not more severe, 
but only more prevalent in Jamaica. 

The influence of the seasons on the prevalence of fevers in 
Jamaica cannot be ascertained in a separate form, from the tables 
in the Report, as the statement at p. 46 from the ^ledical 
Quarterly Returns relates only to four epidemic years ; but even 
this statement proves that the mortality in the second six months 
of these years has been to that of the first six months, in the 
proportion of 1,914 to 692, or nearly 3 to 1. 

In the General Table of Admissions and Deaths by Months 
at p. 71, for a period of 18 years, the admissions during the first 
six months were 27,766, and in the second six months 33,.335, 
by all acute diseases. And the deaths from acute diseases were 
1,751 in the first period, and 3,569 in the second. The admis- 



278 Mortality from Fever in JVindward Sf Leeward Commands, 

sions therefore in the first half of the year, were to those in^ 
second half, as 1 to 1 '2, and the deaths as 1 to 2 -03. 

It may perhaps be objected to this mode of testing thev 
influence of season on the prevalence of fever, that bowel com- 
plaints or other affections, which acknowledge the influence of 
the autumnal season^ caused this increase in the admissions and 
mortality ; but this objection is only specious, as bowel com- 
plaints form only one-fifth or thereabouts of the admissions, and 
caused about a twenty-fourth part of the total mortality ; while 
fever, on the contrary, occasioned three-fourths of the former, 
and five-sixths of the total fatality. If the influence of season 
has thus been less marked in increasing the febrile cases, in so 
far as concerns their number, there can be no doubt of its 
having impressed them with a malignancy, wliich is only the 
more remarkable from its occurrence within the tropics, where 
the variations of temperature, according to the season, are by no 
means great. 

It .may be important to ascertain what eflfect this influx of 
fever patients had upon those with other diseases in the hospitals * 
The Table referred to shows that in 10,258 surgical cases, the 
rate of mortality, in«the first six months, was 3*4 per 1,000, 
while in 8,639 the rate was reduced, in the next six months, to 
2*4 per 1,000. On the contrary, in 3,628 chronic cases, 79 per 
1,000 died in the former, whereas in 2,915 cases, 104 per 1,000 
died in the latter period. These results are contradictory, and 
we may perhaps assume, for the present, that the fever patients 
exerted no very deleterious influence on their comrades in the 
hospitals ; for the more numerous admissions, in the earlier half 
of the year, of cases, which are slow in their progress, would 
lead us to expect a larger mortality at a subsequent period. 

The immense differences in the number of fever cases, and in 
their proportional mortality, in certain localities, diflfering little 
in climate, distance, or surface, from others, might convince the 
most incredulous that the cause of this disease is of local origin, 
or, at all events, local in its action ; otherwise the mean mor- 
tality from fever would not amount to 104'1 per 1,000 in 
Tobago, and fall to 11*2 at St. Vincents ; or rise to 63-1 per 
1,000 in St. Lucia, and sink to 11*8 at Barbadoes ; or reach 
61 '6 per 1,000 in Trinidad, and only 14*9 in Antigua; during 
the long period of 20 years comprised in these Reports. 

On the supposition that the great epidemics are of foreign 
origin, being imported and contagious, it may be said that the 
foregoing examples of its local severity are of no moment, as the 
disease might be introduced into one island without extending 
to others. In order to determine the value of this objection, 
we have only to refer to the Table (60) for Jamaica, where we 
find that at Spanish Town the mean mortality from fever has 

* For effects on Orderlies, see Bancroft's Sequel, &c., p. 186. 



Effects of Removal. 



279 



been 141*1 per 1,000, while at Fort Augusta it was 55*5; at 
Up Park Camp 121 «0 per 1,000, and at Stoney Plill 70-5; 
again, at Montego Bay, 150*7 per 1,000, and at Maroon Town 
15*3 ; and lastly, at Port Antonio, on the north side, 126 per 
1,000, and at Port Poyal, on the south, 93*9; these numbers 
being, in all cases, the average deaths for long periods, and in 
the majority for 20 years. 

In all the latter instances, with the exception of Port Antonio, 
and Port Poyal, the stations are within short distances, the 
communications are frequent between them, and any contagious 
disease ]3revailing at the one might be easily transmitted to the 
other ; and Port Antonio was contrasted with Port Royal, 
because the former is a small port where few ships, unless from 
England or North America, ever enter ; and Port Royal, on the 
contrary, is more frequently visited by vessels from every quarter 
than perhaps all the other harbours in Jamaica. 

If we corroborate the preceding proofs of the localization of 
fever, by the facts so clearly established by this excellent statis- 
tical Report ; viz.. That epidemic fever is rarely if ever absent 
from all the islands in the Windward command, and all the sta- 
tions in Jamaica, though it has never afflicted them all in any one 
year, notv/ithstanding the communications were not interrupted : 
— and that the removal of sick or troops from one post affected, 
to another exempt from its influence, has so frequently arrested 
the epidemic, without endangering others, that removal has 
become the rule, isolation the exception : — The conclusion that 
the disease which decimates our troops in the West Indies is in 
its origin truly endemic, appears inevitable ; and further, that 
whenever it assumes an epidemic form, it is not in any way 
changed in character, or possessed of new or adventitious qua- 
lities of propagating itself, however much it may differ in 
severity, because removal is still effectual in checking its pro- 
gress to the same extent, provided the new locality be suffi- 
ciently elevated or healthy, — as happens always when troops are 
removed from Montego Bay to Maroon Town.* 

Table LXI. (at p. 70) shows that the mortality, at the 10 
principal military stations in Jamaica, has exceeded the mean 
rate of each station by one-fifth, in the following years, viz. : — 

1817, Port Antonio. 

1818, Spanish Town. 

1819, Up Park Camp; Port Royal; Fort Augusta; Stoney 

Hill ; Port Antonio ; Falmouth. 

1820, Spanish Town ; Falmouth. 

1821, Port Royal; Port Antonio. 

1822, Up Park Camp ; Spanish Town ; Port Royal. 

1823, Spanish Town. 

* The two posts of Vivario and Vitzavona, on the high central ridge of Corsica 
enjoy the same exemption from the fatal fevers of Saint Florent and the coast, which 
Maroon Town does from tbosQ of the low-lands of Jamaica. 



280 



Prevalence of Fever ^ partial. 



1824, Spanisli Town ; Port Antonio ; Montego Bay. 

1825, Up Park Camp; Port Royal; Spanisli Town ; Stoney 

Hill ; Falmouth ; Lucea. 

1826, Falmouth. 

1827, Up Park Camp; Port Royal; Fort Augusta; Stoney 

Hill; Falmouth. 

1828, Montego Bay ; Maroon Town. 

1829, Port Antonio. 

1830, Port Royal; Lucea; Maroon Town. 

183 1, Spanish Town ; Stoney Hill ; Falmouth ; Maroon Town 

1832, Port Antonio ; Montego Bay; Lucea ; Maroon Town. 

1833, Port Antonio ; Maroon Town. 

1834, None. 

1835, Spanish Town. 

1 836, Montego Bay ; Lucea. 

As fever causes five -sixths of the average annual mortality 
among the troops in Jamaica, it has been assumed that whenever 
the total mortality at any station exceeded the mean increased 
by one-fifth ; it arose from the prevalence of fever in an epi- 
demic form at that station. 

Should this be admitted (and it appears to me that it can 
hardly be denied), it follows that epidemic fever during the 20 
years comprehended in the Report, was for 6 of those years 
limited to one of 10 stations. 

For 5 years limited to two stations. 

For 3 years limited to three. 

For 2 years limited to four. 

For 1 year limited to five. 

For 2 years limited to six stations ; and for 1 year it did 
not prevail as an epidemic at any one of the 1 prin- 
cipal stations. 

It would appear from the preceding detail of stations that 
no constant relation exists between their proximity, or the 
frequency of intercourse between them, and the prevalence of 
fever ; the only exceptions being in years of wide spreading 
epidemics when several suffered in the same year, though fre- 
quently not at the same time ; thus during the terrible epidemic 
of 1819 at Up Park Camp, though several detachments of the 
50th, and 92nd Regiments, were sent to Stoney Hill between 
July and October, yet fever did not appear at the latter station 
until October, and then the mortality was less than one-third, 
whereas at Up Park Camp it had amounted to half the force. 
The Report, however, says, " It is rather remarkable that 
epidemics generally break out here (Stoney Hill) at a different 
period from that at which they make their appearance in the low 
grounds." 

Detachments were also sent from Up Park Camp to Fort 
Augusta, but at the latter, generally healthy station, the mor- 



Introduction of Fever into Fort Augusta, <^ Marooii Tomi. 281 

tality did not exceed 1 in 10 of the strength. It is, moreover, 
not a little singular, that in Spanish Town, surrounded by this 
fatal disease, the deaths were less than half its annual average 
by fever. In the following year, however, Spanish Town lost 
more than a fourth of its garrison, and kept up its character, 
" that fever seldom appeared in the island, without showing itself 
there in a very aggravated form, and was exceedingly prevalent 
and fatal even at times when all the other stations were com- 
paratively healthy." 

Indeed, from 1822 to 1826 inclusive, this station suffered 
annually from epidemic fever, — while Stoney Hill, situated in a 
mountain gorge at no great distance, suffered in 1825 only, 
among these £ve years. Port Royal, on the east side of the 
harbour of that name, suffered heavily from fever in 1819, 21, 
22, 25, and 27 ; while Fort Augusta, four miles distant on the 
opposite side, suffered considerably in 1819 and 1820, and ter- 
ribly in 1827, but not in any other year. On the north side of 
the island, the epidemics of Port Antonio occurred in J 81 7, 19, 
21, 24, 29, and 33; of Falmouth, in 1819, 20, 25, 26, 27, and 
31 ; of Lucea, in 1825, 30, 32, and 36; Montego Bay, between 
Lucea and Falmouth, and constantly communicating with both,, 
had its epidemics in 1824, 28, 32, and 36; in the two last 
years, Lucea also suffered much ; but Falmouth, 16 miles to the 
east, on the highway to the capital, and indeed on the line of 
greatest intercourse, was very healthy, particularly in the latter 
year. It appears necessary to add, that " Kingston," the garrison 
of which had for some time been furnished from the force in 
Fort iVugusta, " is one of the most unhealthy quarters in the 
island ; and a very great portion indeed of the deaths recorded 
in the above table (p. 55) originated there ; we have been able 
to trace, and deduct not fewer than 56 of these in the year 1825 
alone, but in none of the other years could we effect any accurate 
separation, and can therefore only recommend it to be kept in 
view, that the two companies at Kingston always furnished more 
fatal cases than the four which were at Fort Augusta, and with 
the proper correction on that principle, the mortality cannot 
have exceeded 5 per cent, annually. Though its locality is appa- 
rently so unfavourable," whilst it was thus undergoing an annual 
importation of fever. Fort Augusta presents a lower mean rate of 
mortality than any of the other coast stations in J amaica, during 
the long period of 20 years. 

If we turn to Maroon Town, an elevated and healthy post 
in the interior, we find that "during several years in which 
troops were not permanently quartered at Montego Bay, it was 
customary to send detachments there from Maroon Town during 
the negro holidays, and these always brought back a large pro- 
portion of sick and many fatal cases. The detachments at 
Falmouth and Lucea too, when sickly, have occasionally been 

u 



282 



Differences in the Ratio of Mortality 



relieved by healthier ones from this post, and it has sometimes 
happened that the corps sent to Maroon Town had previously 
been suffering under a great mortality in other parts of the 
island, and brought with them many sick in a dying state. 
After a diligent investigation, it appears that from 30 to 40 of 
the deaths included in the above table (p. 64), may fairly be 
attributed to one or other of these causes, so that the actual 
mortality of the station has not exceeded 22 per 1000 of the 
force annually." 

I may here state that the annual mortality from fever forms 
only about one-half of the total mean mortality at this station, 
consequently the influx of fever patients cannot be said to have 
introduced contagion among the troops quartered there. 

In the stations of the Windward command, the mortality from 
fevers bears so variable a proportion to that from other diseases, 
in the different islands, as to cause less than half the deaths, on 
the average, in the whole command, and the application of the 
same method to determine their epidemic prevalence, would be 
liable to serious objection. 

Besides the frequency of intercourse between the several 
islands being uncertain, it would n,^yer afford the same probability 
of the extension of the disease by contagion, as in the same island 
where communication is always active by means of good roads. 

In the various islands, as in Jamaica, posts at one time occupied 
by white troops have, of late years, been abandoned as unhealthy. 
Without entering, however, into such details, the following 
statements, taken from the Appendix to the Report, will show 
that these colonies have presented the greatest differences in the 
frequency, and fatality of their fever epidemics. From the 
abstract. No. 2, p. 5, of the Appendix^ it appears that fever was 
prevalent and fatal in British Guiana in 1819, 20, 21, 24, 25, 26, 
27, 28, 30, and 31 ; but Yellow Fever is mentioned only in 
1820, 21, and 25. In the first of the latter three years, more 
than half ; in the second, one-seventh ; and in the third, about a 
fourth of the deaths from fever were attributed to the yellow 
variety of this disease. The mortality which was about 16 per 
cent, in 1820, was less than 14 per cent, in 1821, and only 6-6 
per cent, of the white force in 1825. In 1827 and 1828, when 
this variety was not recorded, the loss was 1 2 and 1 1 per cent, 
of the strength respectively. 

In 1818, 30 per cent, of the white troops in Trinidad died of 
fever, and in 1828, the rate of mortality was 13 per cent, while 
in the six years, from 1820 to 1825, the average was only 3*2 
per cent, of the force ; but Yellow Fever is not mentioned in 
this abstract. 

By the return at p. 8, for Tobago, it appears that in 1818, the 
mortality was 13 per cent.; in 1819, it was 18 percent.; in 
1820, it was 80 per cent.; and in 1821, it amounted to 25 per 



from Fever in different Localities. 



283 



cent, of the white force. In these four successive years, about 
four-fifths of the cases were called Yellow Fever; while, in 1817 
and 1830, when this variety was not mentioned, about 14 and 12 
per cent, of the troops died of fever. In five years (of the 20) 
the rate of mortality from fever was under 2 per cent. 

In the abstract, at p. 9, for Grenada, Yellow Fever appears 
twice, — namely, in 1817, when 8-2 per cent., — and in 1818, 
when 2- 1 per cent, died of fever; but in 1819 and in 1828, it 
was not mentioned, though 5 • 7, and 9 per cent, of the force, 
were cut off in these years. 

The abstract No. 7, for St. Vincent's, shows that the average 
annual mortality from fever was 1-12 per cent, of the strength ; 
and in 1822, when one yellow case appeared, the rate increased 
to 2* 1 per cent. ; but in 1824 and 1825, the mortality was twice 
as high, though no such case has been recorded. The return. 
No. 8, for Barbadoes, shows that fever prevailed there in 1817, 
20, 21, and 22. In the first of these four years, the mortality 
was 3*3 per cent, from all fevers, Yellow included ; in the second, 
5 per cent., chiefly from Yellow Fever ; in the third, 7 * 4 per 
cent , one-third of the fatal cases being Yellow Fever ; and in 
the fourth, 3 • 3 per cent, with no Yellow Fever ; whereas, in 
1818, 19, and 27, the rate of mortality was under 1 per cent , with 
one or two cases of Yellow Fever in each of these three years. We 
learn from the abstract, p. 13, that fever was prevalent and fatal 
in St. Lucia in 1818, 22, 24, and 27. In the first of these years 
the mortality was 14-5 per cent. ; in the second, 30 '8 per cent.; 
and in the third and fourth, 21 percent, of the white force; 
while only one case of Yellow Fever is recorded in the second, 
and one in the fourth, and none in either of the other years. 

Dominica appears from the abstract, p. 14, to have lost 29 per 
cent, of its white garrison from fever in 1817; 36 per cent, in 
1821 ; and about 9 per cent, in 1826; though Yellow Fever is 
never mentioned. The abstract, at p. 15, for Antigua and 
Montserrat, proves that, with the exception of 1835, fever had 
not prevailed epidemically within the 20 years, from 1817 to 
1836, as the mortality from that disease rarely exceeded 2 per 
cent, of the strength; notwithstanding, 1 in every 9 fatal cases 
was Yellow Fever, and, moreover, 35 sailors died in the military 
hospitals from this disease, in the single year 1822, in which the 
troops lost only 1 • 7 per cent, of the strength from that, and 
other fevers. 

St. Kitts, Tortola, and Nevis, appear to have suffered pretty 
severely from fever in 1818, 20, 21, 25, 35, and 36; but in three 
of these years the chief mortality occurred in a detachment at 
Nevis ; and in the last year this little island was almost exempt, 
while Tortola and St. Kitts were suffering from fever. This 
group of islands, besides suffering frequently from epidemics, 
exhibits a large proportion of deaths from Yellow Fever. 

u 2 



284 



Not communieahle to Hospital Patients. 



As regards the influence of season, St. Lucia has alone pre- 
sented any considerable excess of mortality from acute diseases, 
in the first six months of the year, as compared with the second, 
which would in part appear to depend upon its swamps being 
often too deeply covered with water, to be highly noxious at the 
latter period. In Antigua and Montserrat, and in St. Vincent's, 
the rate of mortality has been nearly equal in both seasons, but 
in these islands the mortality from fever has been very low. 

In Guiana, Grenada, Barbados, Dominica, and St. Kitts, 
where the predominance of sickness, in the second six months, 
has been more marked, the mortality among 16,289 surgical 
cases treated in their hospitals, in the first half year, has been 
at the rate of 3'7 per 1,000 admissions, whereas among 13,420 
similar cases, in the second half year, the rate has been 4*4 per 
1,000 admissions. It thus appears that seven additional deaths 
took place among every ten thousand of those patients, in the 
season when fevers were most prevalent and fatal. 

The above difference is perfectly appreciable in figures, but if 
it could even be demonstrated to have arisen from the exhala- 
tions of fever patients in the wards, it would not appear very 
formidable. These exhalations, however, would seem to have 
been still less prejudicial to patients suffering from chronic 
diseases, for in 5,764 such patients, 114 per 1,000 died in the 
former, while in 5,442 others, only 112 per 1,000 died in the 
latter period. Are we to infer then from these facts that fever 
may be contagious among surgical patients in the Windward 
Command, and not contagious among them in Jamaica ? Or, 
that it is infectious among chronic cases in Jamaica, and not in- 
fectious in the other islands ? Or that the most fatal form of 
fever is there neither contagious nor infectious ?* Because in an 
aggregate of 66,355 patients, the number appears too large to 
admit of the belief that one half, or any larger proportion of 
them, was altogether unsusceptible of Yellow Fever, or perhaps 
of any fever, of which the contagious, or infectious properties, 
and non-recurrence, have not been demonstrated for all localities. 
Moreover, the closer approach to equality in the number of admis- 
sions, and rate of mortality, among chronic cases, in the two periods, 
in the Windward command, almost proves that the marked differ- 
ence in the latter respect in Jamaica was rather owing to the 
disparity in the admissions in the two seasons, than to any other 
cause, for diseases of this nature are slow in their termination. 

In the Bahamas we find that the mortality among the white 
inhabitants of all ages, was about three times as high as in 
Britain, while the mortality among the white troops there, was 
13 times as great as at home. 

* The terms "infection" and "mediate contagion" are used synonymously: 
matter from ti.e sick, in some form, and contact with some surface, being necessary 
for the communication of a disease, in either way, from ptrson to person. 



Insalubrity of Fort Charlotte, Bahamas. 



285 



" The principal barrack was, till lately, at Fort Charlotte, a spot 
notorious for its insalubrity. It is situated on the summit of the 
little ridge of ground in rear of the town of Nassau, and surrounded in 
every direction, except towards the sea, by extensive marshes, the ex- 
halations from which, during the morning and evening, generally en- 
velope the barrack in a dense fog," p. 72. 

" Shortly after it was erected, in the end of the last century, nearly 
the whole of the 47th Regiment, including men, women, and children, 
were swept off by Yellow Fever within a fetv weeks. In 1802 the 
7th Fusileers buried 220 out of 300 within as short a period, and such 
was the virulence of the disease, that out of 12 officers attacked, one 
only recovered. In the following year it again broke out, and reduced 
the remainder of this force to 50 men, whose lives were for a time 
saved by removal to a neighbouring island, where only one died in the 
course of three months ; but immediately on their re^z^rw, the command- 
ing officer and almost every man of this ill-fated body fell victims to 
the insalubrity of the fort. For some years afterwards no European 
troops seem to have inhabited it ; but 70 men of the 58th Regiment 
were sent there in 1818, who lost about 40 in six months, besides 13 
out of 37 women and children ; not a man of the whole force was left 
fit for duty ; and the lives of the survivors were only saved by removal 
to a small island about a mile and a half distant. The lower rooms of 
this barrack proved much more fatal to the inmates than the upper, and 
the hospital appears to have been still more unhealthy in its site ; so 
much so, that the white soldiers, in sickly seasons, looked upon ad- 
mission into it to be equivalent to a death warrant. Though the health 
of the black troops is, in general, but little affected by those febrile 
diseases which prove so inimical to the white, even that class when 
occupying the same barrack" (p. 73) " suffered severely, particularly 
the men in the lower rooms. In 1828, out of 80 in these rooms, 17 
died, or nearly a fifth of the whole, while, out of 210 in the upper 
rooms, but 8 died ; and in the new barracks at Fort Nassau only 3 
died out of 180," (p. 74). 

" The barrack at Fort Nassau has always been healthy, the accom- 
modation good, and the sickness and mortality among the troops there 
exceedingly low." " These remarks, in regard to the barracks, have 
been deemed necessary, in order that incorrect inferences may not be 
drawn as to the climate of the Bahamas, by attributing to it a degree 
of mortality which seems to have been, in a great measure, owing to 
the troops having continued, for a long series of years, to occupy a 
position which, from its extreme insalubrity, was not unaptly termed 
the abode of death," (p. 74). 

At Honduras the mortality of the small force of white troops 
stationed there, seems to hold an intermediate place between the 
Windward and Jamaica commands, but the Report does not 
furnish any particular details as to local influences on the health 
of the men ; however, all the deaths, excepting six, occurred 
from remittent or Yellow Fever ; intermittents, though frequent, 
never proving fatal. Bowel complaints are not so fatal as in 
other parts of the West Indies.^ 



2S6 Prevalence of Various Types. 



Classification of Fevers, Windward Command, p. 7 of Report. 













Admitted. 


Died. 


Proportion of 

Deaths to 
Admissions 


Common continued 


24,607 
1,973 
133 
17,799 
16,821 
774 
48 
8 


149 

1 

1,966 
726 
331 
11 


1 in 165 
1 in 179 
1 in 133 
1 in 9 
1 in 23 
1 in 2i 
1 in 4| 
in 8 




62,163 


3,195 


1 in 20 


Annual ratio per 1000 of Mean Strength 


717 


36-9 





Total Strength in 20 years .... 86,661 

Average Annual Strength of Force . . 4,333 

Admissions .... 8,247 1 from all Dis- 

Deaths 340 j eases. 

Ratio Admitted per 1000 1,903 

>,, Died ,, 78-5 



The foregoing table from p. 7 of tlie Statistical Report for the 
West Indies, compared with the corresponding one for Jamaica, 
at p. 46 of the same Report, shows such a remarkable predomi- 
nance in. fevers of an intermittent type in the former, that it 
cannot pass the notice of the most careless observer. Even when 
the necessary correction is made for the difference in strength 
of the force in the two commands, we find that five cases of inter- 
mittent occur in the Windward Station for three in Jamaica ; 
though the rate of mortality on the admissions is almost the same 
in both, namely, 1 in J 66 in the former, and 1 in 165 in the 
latter. This rate of mortality from periodic fevers is so ex- 
tremely low, as to lead us to infer, that these diseases are far 
more benign within the tropics than in the temperate zone, but 
such an inference is directly opposed to general experience, 
in so far as regards the influence of both latitude and season on 
fevers of this form, which are said never to prevail epidemically 
beyond the isothermal line, indicating a mean annual temperature 
of 5° centigrade, or not rising above 10° of the same scale in 
summer and falling below C** in winter, increasing in frequency 
and intensity, (the other conditions necessary for their prevalence 
being equal,) as we approach the equator. 

In this dilemma we may therefore adopt, for the present, 
another solution of the question, by supposing that all the severe 
cases of periodic fever are classed under the heads of remittent 
and Yellow Fevers ; an explanation which acquires a certain 
degree of probabilitj^, from the following statement of the rate of 



Yellowness of Skin, an indication of Severity. 287 



mortality in severe epidemics of periodic fever, in other place?, 
viz. : — 





Places. 


NiirD,t>€r of 
Cases. 


Deaths. 


Authorities. 






Rome . . . 
Boifleaux . 
Monti uel . . 
Erco'e , . 
Bona 


93,001 
12,000 
1,35 2 
515 
■22,330 


8,879 
3,000 
113 
115 
2,513 


Bailiy. 
Contanceau. 
Nepple. 
M on falcon. 
Maillot. 






Total . . 


132,198 


14,620 


= 1 in 9 





If we next compare the number of cases of remittent fever 
among the troops in the Windward Islands, with the number in 
Jamaica, we find that the admissions under this head in the 
former, were in an equal strength, in the proportion of 18 to 65 
in the latter ; and, farther, that the mortality per cent on these 
admissions is as 11 to 13*3. 

From the nomenclature in use in the two commands, it might 
be inferred, that fever attended with yellowness of skin was 
almost unknown in Jamaica, while it was nearly 40 times more 
frequent in the Windward Command. 

Now the occurrence of yellowness of skin in remittent, or in 
intermittent fevers, is a well known indication of a severe form 
of these diseases, even in temperate climates, and is by no means 
a rare symptom, especially during their epidemic prevalence in 
the autumnal months ; hence, we may conclude, either that it 
has attracted more notice in the lesser islands from its compara- 
tive rarity, — an assumption, in some measure, warranted by the 
lower rate of mortality, — or, if it characterizes a distinct form of 
fever, that this peculiar disease has been nearly 40 times more 
frequent there than in Jamaica. On the other hand, by including 
the cases under the head of Yellow Fever, among the remittents 
in both commands, — we find that the difference in the rate of 
mortality from these forms of fever almost entirely vanishes, for 
it then amounts to 1 in 8'1 admissions in the Windward, and to 
1 in 7' 5 in the Jamaica Command ; and it was probably, in this 
way, that the reporters came to the conclusion that, remittent 
fevers were not more fatal, but only more prevalent, in Jamaica. 
Vide Rep. p. 46. 

The far greater prevalence of continued fevers in the lesser 
islands, than in Jamaica, may possibly bear some intimate re- 
lation to the predominance of the quotidian type among the 
troops on these stations, or be, in some measure, the complement 
of the extraordinary difference in the number of remittent fevers, 
as they are, proportionally to the force employed, about five times 
more numerous in the one, than in the other of these localities ; 
though the rate of mortality on the admissions is the same in 



288 



Fevers in Sierra Leone. 



botli. On all varieties of fever taken collectively, the admissions 
in Jamaica, exceed those in the Windward Islands, nearly in 
the proportion of 9 to 7 , and the deaths by little less than 3 to 1 ; 
and this difference has been so constant over a long series of 
years, that it could hardly be a result of the accidental inporta- 
tion of a distinct contagious fever, which would probably dis- 
tribute its fatal gifts more equally among a class so similarly 
circumstanced, as to age, habits, employment, and mode of living, 
as British soldiers are, taken in the aggregate ; especially where 
the difference of climate, properly so called, is scarcely to be 
appreciated. 

The Statistical Report for Western Africa shows that the 
average annual rate of mortality from fever, is about four times 
as great in the Sierra Leone command, as in Jamaica. 

The mortality from other diseases is also much higher than in 
that island, and here continues to form about one-sixth of the 
annual average, or, in other words, it has progressed in almost 
an equal ratio with that from fever. It may also be remarked, 
that the classification of fevers has been either different from 
that adopted in Jamaica, or that these diseases differ somewhat 
in the forms which they present on this coast, because inter- 
mittents form less than 13 per cent, of the admissions under the 
head of fever in that island ; whereas they exceed 37 per cent, 
of such admissions at Sierra Leone, and the mortality from them 
is nearly twice as great as in Jamaica. 

It is to an aggravated form of periodic fever, however, that 
the west coast of Africa owes its notorious character for insalu- 
brity. ^' So generally prevalent (say the reporters, p. 9,) is 
remittent fever, either in its aggravated or milder forms, on this 
coast, that, till of late years, scarcely an European ever passed 
12 months without an attack ; " and after mentioning that ulcers 
" seemed to act as a safeguard" and a great tendency to various 
haemorrhages, they add, " Except in these respects there seems 
to have been little difference in the disease from that which 
generally marks Yellow Fever of the worst type in other 
colonies. On this point, it may be proper, however, to remark, 
that, between 1824 and 1829, the black vomit is not mentioned 
in any of the Reports as one of the characteristics of the disease. 
This may perhaps induce a doubt in the minds of those who 
attach much importance to that symptom, as to whether the 
disease in these years was genuine Yellow Fever, or merely the 
endemial remittent of the country, but as the latter is com- 
paratively of a mild character, the cases could scarcely have 
been of that type, when, in general, one-half, and, in some 
instances, three-fourths perished of all those attacked." " This 
•disease did not prove equally fatal at all the stations along the 
coast. At the Gambia, for instance, in 1825 and 1826, three- 



Injiuence of Season, on Fevers. 



289 



fourths died of all those attacked, while at Sierra Leone, during 
the same period, only about half the cases terminated fatally. 
It was also subject to remarkable fluctuations at different periods, 
both as regards prevalence and severity; between 1823 and 
1829, for instance, it raged in the most aggravated form along 
the coast for several months of each year, and cut off a large 
proportion of the white population annually, while in 1830 and 
the six subsequent years it almost entirely disappeared, scarcely 
a case which could be denominated Yellow Fever, came under 
treatment." " Indeed almost every apprehension of the recur- 
rence of fever in an aggravated form had ceased, when in 1837 
and 1838^ without any assignable cause, it broke out with as 
much virulence as during the most unhealthy epoch of the 
colony, and destroyed a large proportion of the white popula- 
tion." Though this formidable variety of fever has in most 
years appeared and raged with the greatest violence during the 
height of the rainy season," there are several exceptions to 
this rule, yet it may be said to have prevailed (like ague) chiefly 
in the autumn and spring. There are no tabular statements to 
show the comparative mortality of the diflferent seasons, at Sierra 
Leone, in a separate form ; but at p. 13 there are ample proofs 
that the greatest amount of mortality and sickness occurred at 
the Gambia, in the last six months of each year, — and that this 
disease, like the Walcheren fever, did not aflfect those on board 
ship, and was therefore a product of the land, — and it also seems 
equally certain that it was exclusively the disease of the Euro- 
pean, because during the whole of this dreadful mortality, a de- 
tachment of from 40 to 50 black soldiers, of the 2nd West India 
Regiment, lost only one man, and had seldom any in hospital." 

The evidence regarding the prevalence and mortality of 
fever among the white troops at the Isles de Los, is equally 
conclusive as to the influence of season ; but the nature of 
the returns from other stations on the coast did not enable 
the reporters to separate the white from the black troops, and 
the total annual mortality for the Cape Coast Command, given 
at p. 19, is not available for the present purpose. At p. 23, 
however, we find a statement for the whole of this coast, which 
shows, that " on every 1,000 recorded," the admissions, during 
the first six months of the year, were to those in the second six 
months, as 329 to 671 ; and the corresponding mortality was, 
for these periods, as 162 to 838. 

The reporters here remark, " The character of these seasons, 
however, is by no means uniformly manifested in this command ; 
1823, 1829, 1837, and 1838, were all memorable exceptions, in 
which fever was most prevalent and fatal during the first and 
second quarters, and disappeared as the season advanced, though, 
at these periods, the white troops were too few, for the admissions 
and deaths to counterbalance the preponderance in the third 



290 



Influence of Season, on Fecers. 



and fourth quarters of other years, when that description of force 
was more numerous in the colony." 

This inference, from the results of a calculation for the five 
years from 1825 to 1829, cannot be considered subversive of 
the statements quoted from previous parts of this Report, for, 
in 1 829, the mortality from fever did not exceed 7 per cent, of 
the force, (8 in 114), nor the admissions from that disease, 77*2 
per cent, during the year. 

Again, if, in 1 822, nine in ten died of fever, the great majority 
must have perished of second attacks, because, with an average 
strength of 10 men, there were 22 admissions. In 1823, a 
strength of six men presents us with eight admissions, and six 
deaths ; but here the number appears to be too small to warrant 
any general conclusion, and in no other year up to 1836, in- 
clusive, (the last which has been published) was the proportional 
mortality from fever, — 33*4 per cent, among the smaller white 
force — half so great as among the largest (571 men) in 1825, 
when it amounted to 68 per cent. Turning from Appendix 
No. 1 which has furnished these figures, to the Table p. 23, we 
find that the presence of a greater number of soldiersj only 
doubled the admissions; but it multiplied the mortality five* 
fold, during the last six months of these years, a fact which con- 
firms what has been already observed with regard to Jamaica,—- 
namely, that the mortality during the latter half of the year, 
increases in a greater ratio than the admissions. 

Neither can the inclusion of the black troops in this table, be 
supposed materially to vitiate the inference just drawn, because 
we learn from Appendix No. 2, that they lost only three men 
from fever during these five years, and that 30 out of 79 deaths 
among them, during that period, were caused by small-pox, and 
probably occurred chiefly in the second quarter of the year, 
1827, a circumstance which would tend to diminish, rather than 
to increase, any error from this source. 

Should the influence of the autumnal season in augmenting 
the number of attacks of fever on the Western Coast of Africa 
not appear to be sufficiently established by what has been stated 
above, I might adduce farther proofs from the tables at pp. 236 
and 240 of Thevenot's work on ''the Diseases of Europeans in 
hot climates, particularly in Senegal;" but the following ex- 
tracts from pp. 237, 2 '38, may possibly answer the end, viz. : 
*' In all these localities the autumn is always the worst season ; 
but it is in the months of October and November that the most 
intractable diseases appear. The second six months of the year 
present four-fifths of the whole annual sickness at Senegal. It 
is a period justly dreaded by Europeans, particularly the end 
of September and October." The shortness of the periods for 
which white troops were employed at many of the garrisons on 
this coast, does not enable us to determine the influence of each 



Statistical Report of the Navy. 



291 



locality on the number and severity of febrile diseases at the 
several stations, with the same degree of certainty as in the 
AVest Indies, but the comparative statement at p. 14, for the 
years 1825 and 1826, proves to demonstration that great dif- 
ferences exist even in the same years, though it does not warrant 
lis in saying how far these differences may be of a permanent 
character. 

The great prevalence of intermittents on the African coast, 
compared with the West Indies, has been previously alluded to, 
and the table at p. 240 of Thevenot's work, shows, that in 
Senegal, this type is six times more frequent than the remittent. 
This author also informs us, p. 244, that Yellow Fever is rare 
in the vicinity of Senegal, though it has twice appeared on the 
arid sands of Goree. It seems almost superfluous to remark, 
that the climate and topography of these settlements are very 
different from those of the English colonies to the southward, 
as the latter are never parched up and converted into barren 
wastes, for a certain portion of the year, like the plains of Senegal, 
— or, on the contrary, almost entirely laid under water for a month 
or two, at another season of every successive year, by the rivers 
swollen from the rains which fall in the interior ; for at St. Louis 
the average annual fall of rain is said by Thevenot to be only 
20 inches (French) ; while, at Sierra Leone, it seems to be more 
than ten times as great. 

An examination of the statistical Reports of the army having 
shown that the prevalence and mortality of fevers in the West 
Indies, and on the western coast of Africa, are greatly, if not 
equally influenced by season and locality, the statistical Report 
on the Navy for the North American and West Indian station, 
from 1837 to 1843, was next referred to, and with the single 
exception of 1840, in which the admissions and deaths from fever 
were lower than in any other of these years, the influence of the 
second six months, in augmenting the number of cases, as well 
as the mortality of this disease, is as strikingly evinced, as in the 
Reports for the Army. 

The quarterly returns, introduced by Dr. Bryson, in this 
series, show that the admissions in the first six months of these 
years, were 2,600; in the second six months, 3,731 ; and the 
deaths in the former period, were 92 ; in the latter, 'i30 ; the 
mortality, therefore, was in the ratio of 3 ' 53 per cent, to the 
admissions in the one, and 6*16 per cent, in the other, — a 
result in perfect accordance with the observations already made, 
that the mortality increases in a greater ratio than the attacks, at 
this season. 

It could scarcely be expected that any striking illustration of 
the influence of locality, in developing or aggravating fevers, 
would be afforded by the returns for the navy, in consequence 
of the frequent changes of place incident to this service; but the 



292 Progress of the Epidemic in Spain, 1804. 

Table^ No. 3, at p. 129, exhibits the eiFects of this climate in no 
favourable light, when contrasted with the Table at p. 41 for 
the South American station. 

The Returns in the Appendix also show, that fever is both 
more frequent and fatal in steam vessels than in others ; but it 
would be necessary to know the strength of the crews, in every 
instance;, before the amount of this apparent difference could be 
determined. Thevenot gives at p. 177 some remarkable proofs 
of the mortality from fever among the crews of vessels in the 
rivers of Western Africa ; and the experience of the royal navy, 
has only too frequently exemplified the danger of exploring them. 

It would be quite superfluous to enter into any details for the 
purpose of showing, that in the United States, and in Spain, 
Yellow Fever epidemics have been, in all instances, strictly 
limited to the last six months of the year, — that being the period 
in which the endemic fever of the West Indies, and of Western 
Africa, is also most prevalent and fatal ; but a cursory glance at 
the table given by Arejula, for the calamitous year 1804 may not 
be altogether useless. 

From that document we learn that the epidemic broke out at 
Malaga on the 29th of June ; — at Y elez, and at Antequera, — the 
former about 10, the latter about 18 miles distant from that city, 
it appeared on the second of August ; at Alicant on the 9th ; at 
Montilla on the 11th; and at Arcos on the 14th of August. 

A reference to a map of Spain will show, that if Yelez and 
Antequera are within a few hours walk of Malaga; Montilla and 
Arcos are remote, and not even on the main line of communica- 
tion. Assuming Montilla to be a new point of departure, it 
travelled north 20 miles to Cordova, between the Uth of 
August and the 28th September ; for Arejula ridicules the idea 
of its being introduced by "un lino," from Malaga, and says 
the communication was as free as between Madrid and Cara- 
banchel, or, to use an illustration near home, — between London 
and Hampton. 

Its progress, however, in this direction, had been compara- 
tively rapid, for it took 10 days longer to reach Ecija, only 10 
miles west of Montilla. On the 28th of August, the inhabitants 
of Cadiz were variously blaming Malaga, Gibraltar, or Havannah, 
for sending them this fatal scourge, while it had been quietly 
established for a fortnight at Arcos, on the Guadalete, about 18 
miles from them, and half that distance from Xeres, which it 
nevertheless did not reach until the 23rd of September. 

From Alicant it travelled 12 miles to Guardamar, at the mouth 
of the Segura, between the middle of August and the 21st of 
October; and finally it managed to get over the 10 miles of 
ground from Paterna to Ximena between the 30th of August 
and 27th of October. If the cross roads of Spain be not very good 
at the present day, they were probably worse in 1804; we need 
not, therefore, be greatly surprised that Yellow Fever turned 



Nature of the Spanish Epidemic, 1804. 



293 



aside from many places which appeared to lay almost on its path ; 
but having reached Cordova, with one of the best roads in the 
country apparently open, the epidemic could not ascend the 
central table land of Spain, (one of the highest in Europe,) to 
visit the capital ; probably from the same obstacle that has foiled 
it for centuries, in gaining the table land of Mexico from its home 
at Vera Cruz. 

It would thus appear that the outbreaks of Yellow Fever are 
about as little subject to any rule of gradual progression j as those 
of Cholera were in its late visit to this country ; and it may now 
be well to inquire if its ravages were not as capricious as its 
course. With regard to this point, the same table shows that 
Velez Malaga lost about 3 in 7 of its inhabitants, while Cordova 
lost 1 in 130; Vera lost half its population, whereas Grenada 
lost 1 in 180; at Carthagena de Levante I in 3 perished; at 
Ximena 1 in 150; at Malaga, nearly 1 in 3 inhabitants died; 
at Ecija, less than 1 in 10. 

Thus in the same epidemic, in the same country, whether we 
compare large towns with small villages, or large towns with one 
another, the contrast in the mortality is equally great as in 
Cholera, and the influence of locality can scarcely be doubted. 

It was almost necessary to have some such evidence as this 
from the Peninsula, because the prevalence of Yellow Fever 
there in 1804, has been at least generally admitted ; and the 
inflammatory, bilio-inflammatory, or complicated remittent, has 
not hitherto been accused of usurping the place of the genuine 
Bulam, in that year in Spain. Arejula very quaintly informs us 
(p. 154), that none of the profesores" of medicine and surgery, 
knew the disease to be an intruder when they first saw it in 
Cadiz in 1800; this also occurred at Medina Sidonia in 1801 ; 
and again at Malaga in 1803, " noticithstanding such patients had 
fallen into the hands of able physicians, who had treated a consider- 
able number of cases of this same fever in 1800." 

Indeed, he so frequently mentions remissions, and at p. 168, 
many of the signs of pernicious fever, as occurring in the course 
of this disease, that his own belief in its distinct or specific cha- 
racter, cannot be deemed fixed, especially when we consider the 
treatment (by Quina) he so strongly recommended; and at 
p. 147, he literally refers its differential diagnosis to the attention 
of the medical ofiicers of the navy, in his indecision as to its 
identity with the non-contagious " vomito prieto." Had the 
learned doctor been alive, he might possibly have found some 
satisfactory information on this point, in the valuable Reports of 
Dr. Bryson on the navy, and of his fellow labourers of the army, 
in the field of statistical inquiry ; here, however, the question of 
diagnosis may rest for the present ; but the skilled in nice dis- 
tinctions, or, as Arejula calls them, " pure scholastic differences," 
will find enough to gratify their curiosity in this way, in the 
articles on Remittent Fever, and Hsem agastric Pestilence, by 



294 Amount of Immunity from Second Attmks. 

Dr. Copland ; and at p. 509, of the Monography of Mongellaz, 
they may read a case of pernicious intermittent, detailed by 
Trousseau, in which the black matter vomited, was " tout a fait 
identique," with the black vomit of patients suffering from Yellow 
Fever. 

It is a commonly received opinion that previous attacks of 
Yellow Fever, or simply length of residence in those particular 
localities where that disease frequently appears, independently 
of any attack, will afford to persons so circumstanced, a certain 
degree of immunity during its epidemic prevalence. This be- 
lief, however, has received many rude shocks of late years, from 
the statements and figures of the statistical reports, and the 
authority of writers, who like M. Catel, (p. 80,) think "the 
typhus icterodes may attack the same individual several times, 
provided he be in that state of health which favours the develop- 
ment of this inflammation." I have been tempted, therefore, to 
examine the question a little, in order to ascertain how far this 
opinion may be founded on fact. The difficulty (or utter impos- 
sibility) of distinguishing the slighter forms of Yellow Fever, 
from other febrile diseases of the localities where it appears, 
unless by its epidemic prevalence, is generally admitted ; as well 
as the rarity of recovery, after attacks attended with (" los acci- 
dentes," Arej., p. 159) yellowness of skin and black vomit. Dr. 
Blair informs us (p. 83) that these symptoms coincide in only 
6 • 95 per cent, of the number attacked ; and the great mortality, 
84 * 72 per cent., among the so characterized cases, proves the 
inutility of relying on these rare examples — about 1 per cent, of 
the total cases — for the appreciation of this immunity. The only 
sources of positive information then, really available for this pur- 
pose, are the returns in the statistical Reports, especially for 
J amaica ; and as no one has hitherto attempted to prove that 
length of residence there, diminishes the frequency or mortality 
of any other disease of that climate, it may be assumed that any 
advantage to be secured by acclimatization, extends only to 
febrile diseases. 

In estimating the influence of length of residence on the mor- 
tality among the troops serving in Jamaica, we surely cannot be 
warranted in excluding the years in which epidemic fever pre- 
vailed, because many writers suppose the alleged immunity to be 
exclusively limited to the periods of such visitations. 

Neither can we fairly consider a soldier, or stranger, to be fully 
inured to a tropical climate, by a residence of less duration than 
from three to five years. If the latter period be adopted as 
affording a greater probability that a regiment had passed 
through, at least one epidemic season; on turning to Table 
LXXVI, p. 92, of the Statistical Report, we find that the average 
mortality, during the first five years of service, was in the ratio of 
147*7 per 1000, whereas in the second five years, it was 



Comparative exemption of the Negro. 



295 



104 • 7 per 1000 of the strength. If we now examine Table 
LXXVII., p. 93, from which the great epidemic years are 
excluded, we find that the mortality, in the first five years of 
service, was 102 per 1000, and in the second five years, 82 per 
1000 of the strength. This result, which is in accordance with 
common belief, presents us with a curious fact, — namely, that the 
immunity, or advantage, enjoyed by the acclimated, is not con- 
fined to epidemic years, though in such years it appears to be 
about twice as great as in ordinary years ; the diminution of the 
mortality, amounting in the former to 4, and in the latter to 2 
per cent, of the force respectively. As the tables include a 
period of 10 years only, these results might perhaps be modified, 
to some extent, by observations continued over a long series of 
years, but the numbers under observation, and the acknowledged 
accuracy of the returns, may be admitted to give this alleged 
immunity a degree of authenticity, which it could never have 
acquired from individual experience, limited as that experience 
necessarily must have been, to the few survivors of duly charac- 
terised attacks of Yellow Fever. 

I may further remark, that the remittent fever of Jamaica, 
which has been generally considered to attack the same person 
again and again, either, does not in reality do so, or, if old resi- 
dents sufier from repeated attacks, it is certain that such sub- 
sequent attacks must be much less fatal ; and the difference 
between the epidemic and endemic forms of fever, would thus 
appear to be simply in the amount of protection afiforded by 
each variety of the disease, as regards the rate of mortality, — this 
property being common to both. It would further appear from 
the observations of M. Boudin (Ess. de Geographic Med. p. 46) 
that pernicious fevers, the periodic nature of which cannot be 
disputed, have never, in his experience, returned in the same 
individual a second time. 

I have examined the Returns for Jamaica, only, with reference 
to this immunity, because the great differences in the rate of 
m,ortality from fever, in the several islands in the Windward 
Command, must prevent the same importance being attached to 
th€ latter Returns, with regard to this question, so long as the 
troops shall be frequently moved from one island or government 
to another ; moreover, diseases of the stomach and bowels are 
four times more fatal in the Windward Command, (in Dominica 
13 times) than in Jamaica, and it is generally allowed that these 
diseases are aggravated by length of residence. 

The comparative exemption of the negro race from the fatal 
fevers of Sierra Leone is demonstrated by the Table at p. 16 of 
the Report ; but the returns for the West Indies prove, that in 
general, the African is there more liable to fever than in his 
native land. Nor will it be easily credited by those who have 
not looked into these Reports that his rate of mortality from 
that disease is twice, thrice, or even five times as great, in some 



296 



Question as to Causes of Yellow Fever. 



of these islands as in others ; and although the maximum of this 
rate does not coincide in every island with the maximum among 
the white troops, there is nevertheless such an approximation 
between the maximum and the minimum, for both races, on the 
same stations (p. 51 ) as would lead us to infer that they both suffer 
from the same local causes. A striking fact of this kind at 
Nassau, already quoted from the Report, seems of itself so con- 
clusive, as to render abortive any attempt to found on these 
occasional occurrences a specific distinction* between Yellow 
and Remittent Fevers, an application of them (to diagnosis) by 
the way, which might lead to the inference that Yellow Fever 
was more than four times as prevalent at St Kitts, &c., as at 
Sierra Leone. 

Medical men entertain very different opinions regarding the 
cause of Yellow Fever ; some attribute the disease exclusively 
to a specific contagion either mediate or immediate ; some 
believe that it may become contagious at one time, or place, 
from accidental circumstances, and not be contagious in another ; 
and many maintain that the cause is of local origin, and that the 
disease is never contagious. 

This question of origin has given rise to much bitter contro- 
versy among medical men, but I shall not enter into any detail 
upon a subject which has occupied the attention of others better 
qualified for the task. 

However, it appears necessary to remark, that the great mass 
of evidence contained in the statistical Reports of the Army, is 
adverse to the doctrine of contagion ; while the evidence in the 
Reports for the Navy is, in a few instances, of an opposite cha- 
racter ; a result which might naturally be expected from the 
circumstances under which the disease had there been observed. 

The Reports agree in showing that remissions have been 
present in a great majority of the epidemics of fever in the West 
Indies and Western Africa ; that these epidemics may not occur 
for years in some of the worst localities ; that they may return 
without any assignable cause, and prevail with various degrees 
of intensity, for long periods ; and that black vomit may not be 
noticed, or in a few cases only, in the most fatal epidemics on 
the African Coast. 

These differences have been alleged, by the contagionists, to 
depend upon the prevalence of two distinct diseases, either 
simultaneously or at different times, in the same locality ; and 
Dr. Copland says, Much of the misconception which formerly 
existed respecting these maladies, was owing to the unfortunate 
names given to them, especially to the the term Yellow Fever, 
which, as ^\\\\ be seen from what has been adduced from various 



* Copland, Dictionary of Practical Medicir.p, p. 951, vol. i., and note, p. 173, 



Characteristics of the disease. 



297 



writers, was generally applied to this pestilence, although yel- 
lowness of the surface was more remarkable in the severe 
endemic remittent not only of Africa and America, but also of 
Spain and the shores of the Mediterranean." * 

The yellowness of surface, which is here allowed to be more 
remarkable in the severe remittent, forms only an instalment of 
what was justly due to that disease, for the same author is obliged 
to concede a share of the black vomit, and the best observers 
have established its claim to a great number of cases of an appa- 
rently continued form, among the fevers of hot climates, — the 
pseudo-continued of some French authors. It would thus 
appear that remittent, had at least as good grounds as Yellow 
Fever, to complain of an unfortunate name, which has deprived 
it of its undoubted rights. The reporters, therefore, were jus- 
tified in adhering to the nomenclature in general use, because a 
little more or a little less black vomit occurring in these fevers, 
is a very insufficient distinction at the bedside of a patient, and 
no unequivocal diagnostic symptoms present themselves during 
the course of the disease. The short duration of Yellow Fever 
has been relied on as a distinctive characteristic of that disease, 
but in an epidemic, evidently from local causes, at La Graverie 
(Calvados) in 1809, death took place, in a majority of the cases, 
in 6, 8, 1 2, 1 5, 20, and 24 hours from the attack, and I am not 
aware that Yellow Fever has ever proved so rapidly fatal ; its 
duration, however, differs in different epidemics.! Moreover 
the (disputed) infectious quality is admitted to be so easily dis- 
sipated by winds, that it may not be manifest ; there may be no 
sufficient reduction of temperature, to test the power of endu- 
rance of the disease in this way ; and in order to be enlightened 
by the immunity from second attack, we must wait for the next 
epidemic. Indeed the more this question is examined, the 
greater does the difficulty of establishing any invariable charac- 
teristics of Yellow Fever appear to be ; but it is unnecessary to 
prosecute this subject farther, as the distinct nature of Yellow 
Fever is founded upon belief, rather than observation. 

It has been already stated that periodic fevers are rare in high 
northern latitudes, and that they increase in frequency and severity 
as we advance southwards ; the other conditions necessary for 
their prevalence being equal. It is not in frequency and severity 
alone, however, that these diseases become modified, by the 
influence of a high temperature in augmenting the intensity of 
the cause. Their forms also are so much changed, that the 
periodic character would be no longer recognized by those who 
had observed them only in northern climates. In this progress 
towards the equator the tertian is supplanted by the quotidian, 
the latter by the remittent, and this again in its turn becomes 

* Dr. Co])land, Dictionary of Practical Medicine, vol. iii., p. 166. 
t Montfalcon, p. 478. 

X 



298 



Effects of Malaria on Animals. 



partly superseded by the subintrant, tbe pernicious, and tbe con- 
tinued, either with or without yellowness of skin and black 
vomit ; the mortality also keeping pace with these transforma- 
tions. These conversions into different types occur not only in 
passing from high to low latitudes, but they appear in temperate 
climates, according to the season of the year, and the violence 
of the various epidemics. 

Nor are these all the circumstances which compel periodic 
fevers to undergo such evolutions, for even within the tropics 
we may sometimes see the same series, inverted in its order, 
in ascending from the low lands on the coast, to considerable 
altitudes. In conforming therefore to this influence of season 
in temperate climates, and in ceasing to appear at certain 
altitudes within the tropics, as well as by its symptoms. Yellow 
Fever betrays an alliance with periodic fevers. The affinity, 
however, does not stop here, for it has been observed that both 
varieties of the disease attack strangers, especially those from 
northern countries, in a violent or fatal form, while the native 
or long resident population, may be suffering from a milder 
grade of the disease, a fact pointed out long ago by many 
authors, more particularly by Arejula, and lately confirmed by 
the numerical statements of Dr. Blair. 

Another feature of resemblance likewise throws its weight 
into the same scale, namely, the influence of the cause, whatever 
that may be, upon the health of the lower animals as well as of 
man. Arejula, in his description of Yellow Fever, frequently 
refers to such occurrences, particularly at p. 236, and Sir W. 
Pym, Drs. Gillkrest and Smith, have noticed this fact in the 
Gibraltar epidemic of 1828; and Dr. King more recently at 
Boa Vista. On the contrary, M.M. Dupuy, of Alfort, Rodet^, 
and Hurtrel d'Arboval, have observed intermittent in the horse 
and other animals. In speaking of the notorious insalubrity of 
the district round Brouage, M. Melier says, " The mortality not 
only strikes down man, it also reaches animals. In this melan- 
choly country, as in all others which are insalubrious, epizootic 
diseases advance in line with epidemics." 

The opinion that tbe so-called Y^ellow Fever is merely a 
variety of the pernicious forms* of periodic fever, appears to be 
gaining ground, and it derives no small support from the sudden 
occurrence of adventitious symptoms ("los accidentes," Arejula,. 
pp. 160 and 168) during the progress of the disease ; from the 

* The term pernicious has been applied exclusively to fevers, fundamentally of a 
periodic character, whether their type be intermittent, remittent^ or apparently continued, 
in which violent and extremely dangerous symptoms, such as furious delirium, coma, 
the state called algid, or vomiting and purging of watery or bloody fluids, &c., &c., 
come on suddenly during the progress of the disease, and either prove rapidly fatal, or 
if the patient should recover, the transition from extreme danger to safety, or health, is 
as abrupt as the invasion was unexpected. Moreover, fevers of this irregular type, 
and remittents, are far more rarely followed by such sequelae, as dropsies, &c., than the 
ordinary intermittent, especially when the latter assumes a chronic form. 



Inquiry relative to Morhijic Agents, 



299 



nearly similar rate of mortality ; and above all, from tlie appear- 
ance of undeniable cases* of pernicious fever during Yellow 
Fever epidemics. A case of pernicious intermittent has already 
been referred to, in which, says M. Trousseau, the black vomit 
was '^perfectly identical" with that which is thrown up by 
patients labouring under Yellow Fever, and here, at least, the 
competency of the observer cannot be disputed. Pugnet men- 
tions vomiting of black matter as a fatal symptom in the Dem- 
el-Mouia, (a form of pernicious fever) in Egypt ; Lancisi also 
records the appearance of brown and black vomit, and stools, in 
an epidemic at Fesaro, in 1708 ; and the latest observations of 
this occurrence in Europe appear to be those of M. Garnier, in 
the French hospitals, at Rome, and even at Versailles, as I have 
been informed by M. Bbudin.t The sudden appearance of black 
vomit, after what is commonly called the fatal lull (remission ?) 
in Yellow Fever, is so similar to the rapid invasion of pernicious 
symptoms, in epidemics arising from paludal infection, that it must 
strike the most inattentive observer. These remarkable transi- 
tions, moreover, are exclusively peculiar to the pernicious variety 
of periodic fevers, and the risk of a return in this pernicious form 
appears to be at least as inconsiderable as in Yellow Fever. 

After tracing some general features of resemblance between 
diseases said to be different in their nature, and distinct in their 
causes, it may be well to cast a glance on this latter part of the 
subject, premising that I consider the cause to be the same for 
both varieties, namely, paludal infection, or malaria, for its sources 
are not always obviously paludal, at least, in external aspect. 

The morbific agent, which gives rise to the numerous varieties 
of fever of an essentially periodic character, is generally believed 
to be the product of those reactions, which take place between 
the remains of organic matter and inorganic substances, when 
they are brought in contact under the conditions necessary for 
such reactions. A few have denied the efficacy of this agent, or 
even its existence ; M. Boudin, and one or two others have 
maintained that the effluvia of certain living plants will cause 
fever, — and Dr. Wilson has advanced the opinion, that the slow 
changes going on in ligneous fibre will produce the same efifect ; 
and a remarkable occurrence on board the " Vestal " appears to 
support his views. This ship had taken on board a quantity of 
green firewood, which was supposed to cause a disagreeable 
smell, perceived soon after in the hold. The wood was, in con- 
sequence, got on deck, and some men, chiefly marines, were 
employed to strip off the bark, all of whom were taken ill "in 
the course of two, or at most three days" afterwards. J Other 
accidents of a somewhat similar nature might be adduced in 

* Pugnet, Arejula, Lewis, Rufz, Dutrolau, Bertulus, Gillkrest, Brown, and Jackson. 

+ Bulletin de I'Acad. de Med.— Aout 1850. 

X Return on Health of the Navy from 1837 to 1843, p. 107. 

X 2 



300 



Mixture of Fresh and Salt Water. 



favour of this theory, which, in reality, differs but little from 
that generally adopted, and appears to rest on as good 
grounds as the opinion of some contagionists, who assert that the 
specific poison which causes Yellow Fever was originally gene- 
rated on board crowded slavers ; or that the disease may be pro- 
duced by the effluvia of putrid cod-fish. 

The Yellow Fever has so frequently appeared in sea-ports, as 
to give a certain air of probability to the assertions of those, who 
believe that this disease must be always imported.* Conta- 
gionists, however, as well as their opponents, have almost 
entirely overlooked the fact, that such ports, generally situated 
near the embouchures of rivers, or on narrow inlets having rivers 
running into them, are more exposed than other places, to the 
causes of insalubrity, which depend on tlfe mixture of fresh with 
salt water. 

Now, this mixture of fresh with salt water is one of the con- 
ditions which is most favourable for the production of malaria, — 
probably in part from the destruction of organic life which it 
occasions, and in part from the elements which it furnishes for 
chemical reactions. The following illustration, taken from the 
report of M. Melier,f will decide this point. 

The locality of the experiment, for such it may be truly 
called, was the Mare mm a of Lucca on the shore of the 
Mediterranean. The ground is divided into three principal basins, 
interspersed with numerous lakes and pools, which for ages had 
been inundated from time to time by the sea, thus causing the 
mixture of fresh with salt water. The insalubrity of this district, 
we are told, was so great, that "inevitable death" was the con- 
sequence of passing a single night during the months of August 
and September, in this pestilential locality. In order to remedy 
this sad state of affairs, in 1740, a valved sluice was placed in the 
Burlamanca, — the channel by which the sea-water entered the 
principal basin, — so constructed as to shut out the tides when 
they rose, and to allow the fresh water to escape when they ebbed. 
These works were finished in 1741. The success was so 
complete, that fevers which had never before failed to appear, 
ceased in the following year, and from that time the district 
became healthy. The village of Viareggio, previously aban- 
doned, became an important place, and a favourite summer 
residence of the first families of Lucca. In 1768 and 1769, the 
fevers suddenly reappeared, as in their worst periods. " What 
had happened? Only this : the sluice had got out of repair, and 
the waters were again mixed." The sluice was repaired, and 
fever disappeared. The deaths which had risen to 1 in 15 were 
reduced in the following year to 1 in 40 inhabitants. The same 
accident occurred in 1784-5, with similar consequences, and the 
evil was remedied in the same manner. 

* See note on the " Eclair," at the end of this paper, 
f Ra])port sur les Marais Salaiits, p. 77. 



Composition of Soil and Waters as Sources of Malaria. 301 



Similar sluices were established at Cinquala in 1812, at 
MotroDa in 1819, and at Tonfalo in 1821. Everywhere the 
success was the same ; the experiment is as conclusive as it is 
undeniable. Similar results have since been experienced at other 
places in Italy, and in France. 

Here, then, we have a demonstrated source of insalubrity, 
especially affecting towns situated on the low alluvial banks of 
tidal rivers, and also calculated to throw much light on the 
occurrence of fever on board ships, without the intervention of 
an imported contagion. In towns differently situated, whether 
on the coast, or in the interior, however dissimilar outward 
appearances may be, the sources of insalubrity, where they exist, 
would appear to be fundamentally the same. In the latter 
localities, the constituents of the earth's surface, which are known 
to vary from one point to another, supply the necessary elements, 
either in a state of solution, in the waters arising from different 
sources, or in saline substances soluble in the water, which falls 
in the form of rain, and the consequent chemical reactions 
between the organic and inorganic materials, take place under 
the same laws as elsewhere. It would be as vain to pretend that 
the insalubrity of any considerable number of localities had been 
traced by actual experiment to this cause, as it would be pre- 
posterous to affirm that the organic and inorganic constituents of 
the earth's surface, the composition of the waters, the influence 
of temperature, of light, of electric currents, and the direction 
and force of the winds, — all essential elements in such inves- 
tigations, — had been determined with even an approximation to 
precision in any one situation. The fact, however, has been 
ascertained for a few districts in Italy, acd its applicability to 
others may fairly be inferred. 

All countries of volcanic formation, for example, contain in 
the rocks and soil an unusually large proportion of soluble saline 
substances ; their crust is generally more permeable to water 
than that of other regions of different origin ; they abound in 
mineral springs, and in many of them the vegetation is par- 
ticularly luxuriant. In these countries, in places which present 
no external signs of marshes, or evident sources of insalubirty, 
fevers of a periodic character are known to occur, in an aggra- 
vated form, and sometimes to decimate the inhabitants. Many 
places in Italy, the whole of the ^^'est India Islands, and no 
small portion of the shores of the Caribbean Sea ; several 
islands on the West Coast of Africa, and portions of its shore, as 
well as localities elsewhere ; have presented the world with a 
melancholy series of proofs in favour of this doctrine. "It is an 
ascertained fact," says M. IMeHer, "that all stagnant waters are 
not equally dangerous ; if there are some, which it is enough to 
pass in order to be infected, there are also others which are 
harmless, so to speak, or only give rise occasionally to a few 



302 Changes in Stagnant Waters as Soin^ces of Malaria. 

slight fevers. On what does this difference depend?" He 
informs us, that he has undertaken an inquiry into this subject, 
which has not as yet been carried so far as to enable him to say 
" even with reserve, that the difference depends on this circum- 
stance, — that in the one case the waters contain sulphates in large 
proportion, while in the others they are present only in trifling 
quantities, or not at all." " But," he adds, " we are inclined to 
believe that it is so." The quantity of water present also mate- 
rially modifies the action of the solar heat, in effecting these 
changes, which give rise to the morbific agent, and M. Carriere 
shows us that surfaces which are but thinly covered, or simply 
moist, are known to be the most dangerous situations. There 
nothing modifies or arrests the action of caloric, and the elabora- 
tion which is its result, is always coincident with an increase in 
intensity of the morbific influence." 

The various changes in the forms of organic life, so constantly 
present in stagnant waters, may also play an important part 
in the production of malaria. In salt-marshes, for example ; 
when the water attains a certain degree of concentration, it 
acquires a rose colour, and may even become as red as blood 
from the development of a new infusorial animalcule, which 
appears after the aboriginal races have perished. At this period 
the water exhales the peculiar odour of the violet or iris, which 
is occasionally so strong as to cause headach and other feelings 
of uneasiness in some of the labourers.* In fresh waters, like- 
wise, similar changes, among the infusorial and vegetable forms 
they contain, would appear to take place under certain conditions 
of temperature and evaporation ; and their relative degrees of 
insalubrity may perhaps depend on such transformations, as well 
as on the partial exposure of their alluvial beds to the direct 
action of solar heat. 

The pond of Lindre-Basse, in the department of the Meurthe, 
affords a curious illustration of the effects of the different con- 
ditions, under which malaria is generated, in modifying diseases 
arising from paludal infection. This fish-pond managed ac- 
cording to the triennial rotation system, common in Sologne, is 
two years under water, and one year dry. In the first year it 
is half filled, and gives rise to intermittent fevers ; in the second 
year it is full, and typhoid fevers prevail ; in the third year, 
after being fished, it is left dry and cultivated as a field, and in 
this year carbuncular affections appear. These diseases have 
succeeded one another as regularly and invariably as the dif- 
ferent states of the pond, for a period of 16 years ;t and the idea 
naturally suggests itself, that diseases which have a common 



* Melier sur les Marais Salants, pp. 20 and 49. 

-)■ A change in the rotation in 1848-9 has altered the order of succession of these 
diseases. — Comptes Rendus, 



Carrying 'power of Winds. 



303 



origin, must have more or less a common nature, however much 
they may differ in outward appearance. 

The material morbific agent resulting from the reactions 
between the remains of organized structures and inorganic 
matter, is considered to be sulphuretted hydrogen, which the 
experiments of Chevreul, Henry, Fontan, Daniell, and others, 
have proved to be one of the products obtained from these 
decompositions, when sulphates are present. 

" At this limit," says M. Carriere, " direct investigation stops. 
It may, perhaps, be able (yet) to discover if this substance, the 
existence of which is proved, does not undergo new modifications 
during its contact with the air, before that final one, when depo- 
sited in the tissues, und mixed with the vital fluids, it eventually 
becomes the agent of this intoxication." 

However this may be, experimental physiology has shown 
that one cubic inch of this gas in 1500 cubic inches of air will 
kill a bird, and one cnbic inch in 800 will in no long time kill a 
dog.* Matteucci likewise informs us that "sulphuretted hydro- 
gen is the only body, which having acted on the blood, even in 
very small quantities, renders this fluid incapable of being 
arterialized by oxygen. f " 

Moreover, MM. Dujardin andDidiot have observed, that after 
intense fevers the aeration of the blood during the separation of 
the fibrine, by beating that fluid, does not restore its bright red 
colour as in the physiological state. if 

Malaria is capable of being conveyed by the winds from the 
place where it is generated to others more or less remote. This 
fact, while it aflbrds a proof of the material existence of the 
agent, also explains the insalubrity of localities where the sources 
of this poison may not exist. M. Melier gives a remarkable 
example of this at Marennes. " When the wind blows from the 
east, north-east, or north, that is, in such a direction as to carry 
away from the t(*vn the eflluvia of the waste marshes, which are 
all to the westward of it, fevers are rare. On the contrary, when 
it blows from the west, south-west, or south, namely, in the 
direction that, passing over the marshes, it carries the effluvia 
upon Marennes, fevers are sure to appear." "At St. Agnant, 
situated on the opposite side of the marshes to Marennes, things 
are completely reversed, it is the east wind that there brings fevers 
with it, the same wind which keeps them away from Marennes." 
The distance to which the effluvia may be conveyed appears to 
be considerable, for, at the season when they are most abundant, 
Rochefort, four or five miles from the marshes, suffers from 
the south-west wind, which carries the effluvia upon it from 
Brouage. This carrying power of the winds appears to be in 

* Carpenter, Hum. Physiology, p. 601. 

f Lect. on Phys. Plienom. of living beings, p. 127. 

X Haspel, Maladies de I'Algerie. p. 376. 



304 



Necessity of further investigation. 



some degree dependent on their hygrometric state ; and the 
accumulation of the electric fluid near the surface of the earth, 
during humid states of the atmosphere,* may perhaps favour the 
development of the effluvia. 

The whole subject, however, requires both extensive and 
accurate observation ; and this alone can enable us to give a 
satisfactory reply to a question often asked, namely, — with marshes 
always present, why should one year be more unhealthy than 
another ? At present we can only reply thus, — the morbific in- 
fluence of marshes, and other sources of malaria, is so manifestly 
subordinate to season, that we must infer there has been some 
diflerence in the meteorological phenomena, our acquaintance 
with this part of the subject, being altogether insufficient to enable 
us to afiirm, that any two years have been in all respects alike. 
Nay, a distinguished authority in such matters informs us 
that " since the beginning of the world, the temperature and 
humidity of the atmosphere have perhaps not been twice in 
identically the same circumstances for eight consecutive days."j 
"What value, then, can we attach to conclusions drawn from the 
observation of states so variable, that even the mean annual 
temperature has scarcely been determined, with all the neces- 
sary precision, at a few points on the surface of our globe, while the 
other meteorological phenomena are yet more imperfectly known ? 
Besides, the few diseases, which are generally acknowledged to 
be propagated by a specific contagion, frequently make little 
progress, without the aid of those peculiar states of the atmo- 
sphere, which, in our ignorance of their nature, have been called 
epidemic constitutions ; and if these conditions are admitted to be 
necessary in the one case, why should they be considered unin- 
fluential in the other ? 

If medical topography has so frequently been unsuccessful 
in reconciling the notorious insalubrity of some localities with 
their external appearances, its failures have arisen from the 
imperfection of the means of investigation employed, — not from 
the impossibility of arriving at more positive results. The facts 
adduced in the works of M.M. Melier and Carriere, show that 
chemistry has hitherto been too often either neglected, or mis- 
applied in such researches. 

The recent labours of Professor C. F. Schonbein, however, seem 
to thi'ow an important light on this subject. The Professor, after 
showing " that the quantity of ozone present in the atmosphere 
at the same place, varies at dififerent times," proceeds to prove, 
by experiment, that this agent decomposes the foetid products 
of the putrefactive processes going on in animal bodies after 
life has ceased ; which products, if not destroyed, could hardly 
fail, in the process of time, to accumulate in such quantities as 

* Arago and Schubler, Carriere, p. 76. 

t Quetelet, Letters on the Theory of Probabilitie?, &c.. p. lOG. 



Value of Evidence for and against Contagion. 305 

to render the air "poisonous, and unfit for sustaining animal 
life." He further adds, that " above all other seasons winter 
is most distinguished by the abundance of atmospheric ozone 
and also^ "that the higher strata of the atmosphere are more 
ozoniferous than the lower ones." Now, general experience 
attests that those diseases, which are almost universally con- 
sidered to arise from malaria, are comparatively rare in winter, 
and that they also diminish in frequency (other circumstances 
being equal) with the increased altitude of the locality. 

M. Schonbein, therefore, justly remarks, As the generation 
of some diseases, such as Yellow Fever, &c., seems to be con- 
nected with certain seasons and geographical positions, it would, 
I think, be worth while to ascertain, by comparative ozonometric 
observations, whether [such] diseases bear any relation to the 
ozoniferous state of that portion of the atmosphere within which 
they happen to occur. Considering the great obscurity in 
which the causes of most diseases are as yet enveloped, and as 
it is, nevertheless, highly probable that some at least, if not 
many of them, are the effects of chemical agents which exist in 
the atmosphere, and have a great physiological effect, i. e., act 
in most minute quantities with great energy upon the animal con- 
stitution, scientific physicians and physiologists should earnestly 
follow out any train of research which promises to increase our 
insight into the connexion between abnormal physiological phe- 
nomena, and physical or chemical agents." * 

Those, therefore, who may possess the amount of scientific 
knowledge necessary in such inquiries, have the field open ; but 
they must always recollect, that it is not by ingenious speculation, 
but by exact and long- continued observation of the physical 
phenomena presented on the spot, that any precise or durable 
information on a subject of so much importance can ever be 
acquired. 

Before quitting the subject, it may be well to appreciate, if 
possible, the value of the evidence adduced, as well by the 
advocates of contagion in Yellow Fever, as by those who oppose 
that doctrine. The contagionists hold the proof on their side of 
the question, though founded on an assumption, to be perfectly 
conclusive, and they further affirm that a few positive facts must 
be entirely subversive of any amount of negative evidence. 

This estimate of the value of these presumed facts, so impro- 
perly called positive, is altogether erroneous, for in order to 
attain certainty, in contagion, as in everything else, the cause 
must be shown to be necessary, and the effect to be invariable. 
Then, and only then, can the relation between cause and effect be 
positive or certain. The only sources of human knowledge 
absolutely certain, are the simple self-evident truths which 



* Medico Cliirurg-. Trans,, vol. xxxiv., p. 219. 



306 



Note on the " Eclair,'' and Boa Vista. 



instantly carry conviction to the mind, sucli as axioms, and 
mathematical demonstration. All beyond these narrow limits 
are mere questions of probability. The absolute exemption of 
very many persons exposed to the risk (hypothetical or other- 
wise) of contagion in Yellow Fever, rests on the direct evidence 
of our senses, and possesses, in consequence, a degree of con- 
clusiveness which cannot be set aside by sophistry. It has 
therefore such a superiority over all conclusions, a posteriori, as 
no supposed instances of communication of the disease can ever 
pretend to, so long as numerous exceptions to that alleged rule 
shall present themselves. Nor would the accumulation of 
10,000 indisputable examples of the communication of Yellow 
Fever, from person to person, make its transmission in an}^ given 
case a matter of certainty, though this event would have become 
more or less probable from the amount of facts in its favour. If 
rigorous observation, and ample experience, under conditions 
free from all exception, should ever raise the testimony in favour 
of the contagious nature of Yellow Fever, to such a position as 
this, in the scale of evidence, it may appear less ridiculous to 
talk of conclusions, a posteriori, as positive facts. Because the 
chances of the disease being transmitted from one person to 
another, may then be made the subject of calculation as a question 
of probability, which, like all similar questions, must be liable to 
fluctuation within fixed limits of possible error. The controversy 
as hitherto carried on, has been a war of words and conflicting 
opinions, in which, all the facts coming under direct observation 
are to be found on the side of non- contagion. Hitherto, the 
bold assertion of the contagionist has been received without 
examination by the unthinking, and with avidity by the timid, 
wko have been thereby erroneously encouraged to look for that 
safety in isolation, which can only be secured by hastening from 
the unhealthy locality, and which the troops in Jamaica have so 
largely experienced in their new quarters, — the mountainous 
districts of the island. 

I have the honour to be. 

My Lords and Gentlemen, 

Your obedient servant, 

A. Browne, M.D., 

Surgeon Half- Pay, 37th Regiment. 
To the General Board of Health, 



Note on the alleged Importation of Yellow Fever into Boa Vista, 
hy the Steam Ship " Eclair;' 1845. 

The appearance of Yellow Fever at Boa Yista, after the 
arrival of the " Eclair" in the harbour of Porto Sal Eey on 
the 2 1st of August 1845, has been often referred to as a proof 



Non-introduction hy fomites^ or intercourse with Crew. 307 



that tlie disease was introduced into the island by that ship 
The evidence, however, as stated by Dr. McWilliam, now 
Medical Officer to the Customs Department in London, seems 
by no means conclusive on this point. 

Immediately on the steamer anchoring, John Jamieson, now 
also of the Customs in London, was sent off to her by the 
Consul, but did not go on board, — as Captain Estcourt had doubts 
whether the ship would be admitted to pratique, on account of 
the sickness prevailing on board at the time. 

Jamieson reported to the Consul what had passed. Mr. 
Rendall then waited on the Governor, and it was ordered that 
Mr. Kenny, a medical practitioner, should visit the ship. Mr. 
Kenny, accompanied by Jamieson, went off accordingly, and 
both went on board. Mr. Kenny, having gone below to visit 
the sick, returned ashore with Jamieson, and they were soon 
followed by Captain Estcourt and the chief engineer. " Captain 
Estcourt went first to the Consul's, and afterwards to Mr. 
Macaulay's." " The engineer, after only a short sta)^ on shore, 
went off to the ship where he had been is not stated. The 
Kroomen remained about the pier until the captain returned to 
his ship in the evening," p. 13. In reply to the next question, 
Jamieson says, " I went on board the same night with the 
engineer, and remained there till half-past 10, when I returned to 
the shore." Jamieson brought ashore in his boat " at least a dozen 
bags of soiled linen belonging to the officers of the ship," which 
he deposited in the Consul's store-rooms for the night, and gave 
to the washerwomen of the town next morning. The list of 
washerwomen given to Dr. McWilliam by Jamieson contains 17 
names ; that in Dr. King's Report, p. 16, contains 19 names. 
Four of the washerwomen died ; and Dr. McWilliam says, at 
p. 82, " I have examined the whole of the survivors, and have 
found that 2 were attacked late in October, 5 in November, 2 in 
December, 3 in January, and 1 not until some time in February. 
None of the deaths took place until fever was general in Porto 
Sal Rey ; so that in none of these cases can the occurrence of 
fever be fairly attributed to infectious matter conveyed by the 
linen." AVe must agree with Dr. McWilliam in this opinion, 
all the more that Anna Santa, in reply to Query 75, " Have 
you had fever?" answers, "No;" and Delphina Barbara, in 
reply to Query 112, Have you had fever during or after the 
' Eclair' was here ?" also answers, " No." Dr. McWilliam, who 
examined the washerwomen some time between the 1st and 30th 
of April, seems, nevertheless, to have found 13 of them who 
had had fever, and one who had not. 

Can the number of washerwomen be incorrect, — or the sum- 
mary of their evidence given at p. 82 of Dr. McWilliam's Report ? 

Having disposed of the washerwomen, we find that Captain 
Estcourt went to live at Mr. Macaulay's on the 25th of August, 



308 Non-introduction hyfomites, or intercourse with Crew. 

and lie nobly devoted the whole of his time to his sick crew, 
until he was taken ill himself, on the 11th of September, and at 
once conveyed to the fort, pp. 78, 79. Here, then, was another 
channel through which a contagious disease might have been 
introduced, but as no bad results followed, it is not even alluded 
to. Mr. Kenny, who visited the sick on board once, and in the 
fort " more than once, — indeed frequently" (p. 81) ; as well as 
Dr. Almeida, who saw them once at the latter place, are not sup- 
posed to have introduced the contagion any more than Jamieson, 
the engineer, or Captain Estcourt. The sick and crew of the 
" Eclair " were landed at the fort on the 31st of August, and the 
officers (gun-room, midshipmen, and warrant) occupied a house in 
Porto Sal Rey at the same time. The house is close to the sea, in 
the part of the town called Santa Barbara, and " the officers and 
their servants were daily in various parts of the town." In this 
house, some of the other officers, the captain's cook, and some 
other servants, were taken ill ; " but they, as well as the purser 
at Mr. Kenny's, " were sent to the fort as soon as they were 
attacked," and no bad consequences arose from this, the best of 
all the sources for a contagious disease to spread from. Previous 
to this, however, leave had been given " to the petty officers and 
a few of the sailors" (p. 82) to go ashore. The seamen seemed 
to have resorted chiefly to the house of a publican called 
Georgio, in Porto Sal E-ey. " It is remarkable that this man 
was attacked with head-ache and general fever on the evening 
of the day he was visited by the 'Eclair's' people;'' but it is 
not so remarkable that, among the many friends who visited 
him during his indisposition, Anna Gaspar and Rosinha San 
Antao should have had slight fever shortly after being at the 
gin-shop ; for Anna Gaspar says (367) she had seen no sick, nor 
does Antao say she had. The only thing marvellous in the 
case of Georgio, is how the " Eclair's" people, who were all well 
themselves, could have given him head-ache and a hot skin, 
unless by treating him with too much grog, a failing common 
with sailors. This channel of introduction is presumed to be 
suspicious ; but " the pear was not yet ripe." 

Let us now see how things went on at the fort with the soldiers 
on guard there. 

Corporal Perez, of the first guard, though indisposed while in 
the fort with the " Eclair's" people, was put on duty after his 
return to Sal Rey ; but, getting worse, was relieved, and was ill 
about a month : his wife, however, who attended him, did not 
fall ill until the sickness became general. He says he was not 
visited by many during his illness, and though Dr. Almeida saw 
him once, his disease could not have excited any suspicion in the 
mind of the doctor : and Dr. McWilliam never put a question 
to him as to the nature of the disease, which evidently occurred 
early in September ; and no attempt has been made to trace the 



Earliest cases of Sickness among Soldiers at the Fort. 309 



epidemic to this source, as it did not appear until the middle of 
October. Pedro Manoel, of the same guard, was not sick at the 
fort, nor at Sal Rey, until there was a good deal of fever there. 
Antonio dos Santos, also of this guard, was not sick at the fort, 
nor until three weeks after he had left it. This man's fever must 
have occurred in September ; and this channel of introduction 
is likewise abandoned. The reason for all this seems pretty 
obvious ; for Dr. McWilliam (p. 83) tells us Dr. Almeida saw 
Perez "during his convalescence :" and the doctor says, shortly 
after his only visit to the fort, he went to Fundas das Figuieras, 
and returned to Sal E,ey on the 19th or 20th of October. As 
Perez left the fort on the 3rd or 4th of September, it is not 
probable that he was again put on duty before the 6th or 7th of 
the month, consequently his disease must have been very trivial 
if he was convalescent before Dr. Almeida left the place ; and it 
seems probable that the doctor only saw him in the last ten days 
of October. Santo's case is equally unsatisfactory, as the disease 
did not break out in barracks until long after, and without dates 
such histories are always inconclusive. 

The second guard was six or seven days in the fort while the 
" Eclair's" sick were there; but the Corporal, Silva, was not sick 
in the fort, and was not sure when he got sick, but there were 
several sick before he was. Manoel Antonio Alves, of this 
second guard, was not ill in the fort, and assisted to bury the 
two Portuguese soldiers about the 21st or 22nd of September. 
On the latter day he was sent back to the fort on duty, where he 
remained a day and a half only, having been attacked and taken 
to barracks at the end of that time {i. e. about the 24th), where 
he was ill four or five days, and weak much longer. Luis Briza, 
the third soldier of this guard, died of fever on the 12th of No- 
vember, but it is not said how long he had been sick. 

The third guard at the fort consisted of two Portuguese 
soldiers, and Miguel Barbosa ; the two former died there, one on 
the 20th, and one on the 21st of September. Barbosa, the only 
survivor, " is not quite sure, but thinks he was about six or 
seven days" in the fort with the " Eclair's" sick, and for several 
days after. He says (218 and 219) that Corporal Agosthino and 
Roquewere taken ill the day after the "Eclair" left,* and (220) 
that the corporal died on the third, and Roque on the fourth, 
day of their fever, which would show that the corporal died on 
the 17th and the private Boque on the 1 8th of September: 
Now, Major Mascarenhas shows that the one died on the 20th, 
and the other on the 21st of the month ; and Pedro Manoel says 

* " But the soldiers had only a week before they were seized with fever come from 
Porto Sal Rey, where, at least in a theoretic view, the condition of the soil during and 
after the rainy season is such as may cause fever. Assuredly many bad fevers have 
been attributed to less obvious causes." — Eeport,ip. 105. Should we suppose that these 
men had carried "the germs of fever in them" from Porto Sal Rey to the Fort, the 
incubative stage would only be about half as long as in the cases of Barbosa and 
Manoel /rom the Fort. 



310 Earliest cases of Sickness among Soldiers at the Fort. 

he attended them " upwards of three days having been sent to 
the fort for that purpose. This same Manoel says, he and Barbosa 
remained about four days on guard at the fort after the death 
of their comrades, therefore they must have been relieved about 
the 25th of September. Barbosa and Manoel, on being relieved, 
were sent to a house in the Pao de Yarella, where they stayed 
about eight days. It was during this stay in the Pao de Varella, 
" with the germs of fever in them," that Barbosa and Manoel 
are supposed to have communicated Yellow Fever to Anna 
Gallinha. Barbosa, however, was not confined to bed until a day 
after he went to barracks, and was then only three or four days 
ill ; and the dates, in this history, prove that he must have gone 
to barracks about the 3rd or 4th of October, and was laid up 
about the 4th or 5th of the month : but, in reply to Query 238«, 
he says Luis Briza was sick in barracks at the same time with 
himself. Luis Briza, therefore, was ill with Yellow Fever about 
36 days ; for we know that Briza died on the 12th of November : 
the evidence of Barbosa, if it be worth anything, would prove 
that Yellow Fever is not so " rapid in its course" as some great 
authorities imagine it to be. His comrade Manoel, after carrying 
the germs of fever in him, for four days at the fort, and eight 
days at Pao de Yarella, was, nevertheless, three or four days in 
barracks before he was laid up, consequently he was attacked 
on the 7th or 8th of October. From these details it appears 
that Corporal Perez carried fever to the barracks about the 4th 
of September ; Privates Santos and Alves about the 24th or 25th 
of that month ; and Barbosa and Manoel in the first week of 
October : but Yellow Fever icould not attach the soldiers before 
it suited its own convenience to do so ; it was, therefore, useless 
to look for the origin of the disease in this quarter. 

The fourth guard must have gone to the fort about the 25th of 
September, and as it remained 12 or 13 days there, it must have 
returned about the 8th of October ; consequently, Pedro Gon- 
zalves, of this guard, must have had the germs of fever in him 
for six weeks, if they were derived from this source, as he is 
said not to have been " taken ill until the first of our (the 
guard) returning to Porto Sal Rey," and he died on the 24th of 
November. 

The first guard was 4 days in the fort with the sick of the 
" Eclair;" the second guard, 6 or 7 days, and this guard left it 
all well ; Barbosa, the only survivor of the third guard, thinks, 
but is not quite sure, that he was there with the "Eclair's" 
people " about 6 or 7 days." If Barbosa be right, all the rest 
must be wrong, for the *'Eclair's" crew were only 14 days in 
the fort ; but his evidence regarding Luis Briza must make the 
advocates of rapid course " doubt the value of his testimony. 

Dr. McWilliam states, p. 86, that the disease had attacked 
several persons in Porto Sal Rey proper, by the end of October, 
and some of the soldiers were sick in barracks at this time." 



Attacks of Pathi and Anna Gallinha. 311 



This statement seems to be fully warranted by the evidence, 
especially by tbat of Dr. Almeida, who says (1565) upon re- 
turning to Porto Sal Key on the 19th or 20th of October — only 
three or four days after the death of Anna Gallinha — I found 
about 20 people sick." All intercourse with the "Eclair's" 
men had ceased between seven and eight weeks before a 
single death took place in barracks ; and no fever of a severe 
or fatal nature had appeared there earlier than in the town, not- 
withstanding, soldiers and they alone, with the exception of 
Mr. Kenny, who died on the 'iZth of November, had been in 
frequent or close contact with the sick belonging to this unfortu- 
nate ship. No doubt some soldiers had been unwell at an 
earlier period, but their maladies had been mild in comparison, 
a circumstance not unusual in epidemics from malaria ; though 
not much in accordance with the progress of diseases possessing 
" highly infectious qualities" (p. 110). Indeed, these qualities 
must have been of extraordinary virulence when their " germs " 
could infect Anna Gallinha, who had only been in contact with 
the sick while the disease was in the stage of incubation. 

Manoel Affonso, the subject of the next fatal attack in Porto Sal 
Rey, is supposed to have had an unlucky blanket from the " Eclair" 
in his possession for a month, and to have visited Anna Gallinha, 
before he was taken ill, in this same Pao de Varella^ the only 
locality in Porto Sal Rey that Yellow Fever would, at this time, 
enter ; but it shortly became less scrupulous in its visits. 

The first case of fever among the 9 labourers, from Porto Sal 
Rey, employed on board the " Eclair," occurred in December. 

The first case among the 2 from Estacia occurred when 
fever was general there. Two cases among the 30 men from. 
Rabil, employed on board the " Eclair/' occurred in September, 
one in October, and the others later. Luis Pathi, of Rabil, was 
the first attacked of all the labourers who had been on board the 
" Eclair." This man who was supposed to have taken a blanket, 
or something from the Eclair/' had, according to his evidence, 
been employed on board eight days. He also says he was taken 
ill about three days after the " Eclair " left ; not at Rabil, how- 
ever, but at Moradinha on the opposite side of the ravine, where 
he was attending a festival. The date of his attack therefore 
was the 16th or 17th of September, and the first eight days of his 
illness were passed in a friend's house at Moradinha ; but the 
germs of this highly infectious" fever would do no mischief to 
his friends in this village just yet. At the end of eight days he 
was conveyed to Rabil, consequently about the 25th of Septem- 
ber. Dr. McWilliam takes the date of attack from his reply to 
654, but from that to 656 it appears less positive ; and as the 
festival was held on the 14th, it was probably on that day, as stated 
by Dr. King. 

Pathi says he was ill in his own house " nearly three weeks," 



312 Simultaneous cases at RaUl and Porto Sal Rey. 

and that his daughter was taken ill about the beginning of 
October, and died in three days with black vomit. Dr. McWil- 
liam, however, says, p. 89, that she was taken ill ten or eleven 
days after Pathi's return, or about the 5th or 6th of October ; 
therefore she must have died on the 8th or 9th. The next girl 
was taken ill four days after the death of the first, therefore on 
the 12th or 13th, and she died in four days; about the same 
time with Anna Gallinha, or earlier if Pathi was taken ill on the 
14th of September. 

Thus two deaths from black vomit fever had occurred in the 
" most crowded part" of the most unhealthy village in Boa Vista, 
at least as early as any similar case in Porto Sal Rey. 

The reply of Jose Marques to 1327, shows that a child of 
Manoel Fachina had died before either of Pathi's children ; but 
no questions were put to Fachina on this point, perhaps because 
he had been employed " only at the coal heap," — and had never 
been on board the " Eclair," — or seen the sick at the fort. If 
in the case of Pathi's children the father himself, or the blanket, 
or something, may be suspected to have communicated the disease ; 
at Fachina's there was no blanket, or nothing, to explain the 
nature of the occurrence. 

This is not the only difficulty in the way, for there is nothing, 
worthy the name of proof, to show that Pathi's fever was con- 
nected with the sick of the " Eclair." Pathi was certainly 
employed on board, and was there when the sick were em- 
barked, but he had not, like Antonio Angela (725), Joaquim 
Pathi (744), or Antonio Maria Simoa (594), assisted in getting 
the sick on board, nor does it appear that he was near them ; and 
it requires an implicit belief in the " highly infectious qualities" 
of the disease, to suppose he was taken suddenly ill with the 
same fever, which was so ineffectual at Moradinha, where Dr. 
McWilliam says, p. 91, " no other case of fever occurred until 
some time in December." In a note at the foot of p. 90 how- 
ever, he says, " there was fever there three weeks after Pathi 
left the village," or as the dates will have it, about the 16th of 
October. These statements do not agree, but on either hypo- 
thesis the disease would do no mischief until brought to the vil- 
lage some time in December, by Magdalena Spence, and even 
then it would not attack one-half of the inhabitants (548), cutting 
off only two residents in a population of 101. Moreover we are 
told that fever comes there occasionally in the end of the year. 

At Estacia de Baixo fever prevailed, but from some ill- 
explained circumstance, it was so mild as to cut off only three 
persons in a population of 256, and one of the three had been 
in Porto Sal Key. Those who have little faith in vaccination, 
would deem the discovery of a locality where small-pox would 
be equally tractable, a matter of no small importance. 

Dr. Almeida says, in reply to 1566, that he had seen ^^in all. 



Cordon established by Dr. Almeida. 



313 



about 150 sick," yet he did not suffer from fever. However lie 
seems to have become prudent, for he left Porto Sal Eey for Boa 
Esperanqa, and from this place he went to Fundo das Figueras 
on the 19th of November. In answer to 1574, he says there 
were no sick at this place on his arrival, but in a few days after, 
a man called " da Cruz," " came from Rabil, and was taken sick in 
the course of a few days ; in a week or ten days after this his mother 
and sister were taken sick, and both died " Dr. McWilliam, 
p. 92, says this man had " slept in a bed at Kabil in which two 
persons had died." A " few days " from the 1 9th of November, 
and " a few days," and a week or ten days " added together, 
would necessarily bring us to the first week in December ; but 
Dr. McWilliam, p. 93, says, " To whatever cause it was due, there 
was no farther extension of the fever until the middle of 
December, when a man, called Antonio Jose, came to the place 
from J oao Gallego, where he had left his sister on her death-bed 
from fever." Dr. Almeida satisfactorily explains all this by the 
precautionary measures he adopted (1574), and adds, " by these 
means I kept the fever under until the middle of December ;" 
and in reply to 1575, extends the time to " at least three weeks 
and in the next answer goes on to tell how Jose rendered all his 
precautions nugatory. An intelligent witness, Lieut. Santos, of 
the artillery battalion, replies to 496, that he went to the 
northern villages on the 29th of November, and to 497 he 
answers, " at Cabe^a dos Tharafes I found many sick ; at Fundo 
das Figuieras only one sick ; and I am not aware that there were 
at this time any sick in Joao Gallego." On his return to the 
villages about the end of December Joao Gallego contained 
several sick, Cabe^a dos Tharafes contained a great many sick, 
and the people of Fundo das Figuieras had established a cordon 
sanitaire between Cabe9a dos Tharafes and their own village. 
To 501, " Then was Fundo das Figuieras quite healthy at this 
time?" he says, " No, there were several sick people in a house 
that had been converted into a hospital." Dr. Almeida left the 
village on the 23rd of December, and (1581) says " there were 
a good many cases" at that time. It would appear from all this 
that Joao Gallego had no sick on the 29th of November, (in 
despite of 2 soldiers having been sick there on the 3rd of the 
month (476) ; while Fundo das Figuieras had one; yet the former 
had not only become sickly, — but also infected Fundo das 
Figueiras within 24 days, — notwithstanding the cordon and other 
precautionary measures, which, imperfect as they were, had yet, 
according to Dr. Almeida, kept the disease under " at least three 
weeks." 

It has been seen that Dr. McWilliam says, Antonio Jose got 
into the village about the middle of December : though well on 
his arrival " he was soon laid up," and had done all this mischief 
within a week ; though " da Cruz " had been comparatively 

Y 



314 Remarks of Dr. Mc William on Report of Dr. King. 

harmless in November. Such is this history of the double im- 
portation of fever into Fundo das Figuieras, and of the efficacy 
of cordons and separation of the sick, &c. 

At Porto Sal Rey itself, with the exception of the remark- 
able" case of Georgio in August, doubts might be raised as to 
who was the first sufferer from fever, for Romess says (315) I 
was taken ill about the same time as Anna Gallinha ; and 
Jamieson confirms this statements But in reply to (318) Romess 
says he was taken ill " three days, it might be a day or two 
more," after his wife got the clothes of Manoel and Barbosa to 
wash; and she got these clothes (317) the day the two soldiers 
came to the Pao de Varella, — consequently about the 24th or 25th 
of September, — and the intervals stated would carry his attack 
back to the 1st of October. The reply to 331 likewise shows, 
that Gallinha, Affonso, and Bent, were all ill at the time Romess 
was ; and this might very well be the case, as (319) he tells us 
he was ill nearly two months." The replies to 683 and 1253 
would seem to render it by no means a " positive fact " that even 
Luis Pathi was the very first person attacked in Rabil ; but with- 
out dates no evidence on questions of priority as to time, can be 
considered worthy of the smallest consideration. 

Not a few discrepancies are seen in the evidence given by 
various witnesses, and in many places we find blunders of a 
grosser kind; for example, Dr. Almeida (1564) denies that he 
was in the fort a second time, and assigns his absence from Porto 
Sal Rey as a reason for this ; whereas, Barbosa (228) and Manoel 
(237) assert that Dr. Almeida saw the two Portuguese soldiers 
there during their fatal sickness. 

Dr. McWilliam, in his Remarks on the report of Dr. King, 
relies on the same assumption, viz., that Yellow Fever was in- 
troduced into Porto Sal Rey by the soldiers, Miguel Barbosa 
and Pedro Manoel, and by them communicated during their 
temporary sojourn in the Pao de Yai-ella, to Anna Gallinha, 
Michael Affonso, and others. In a note at p. 1 of the Remarks, 
the date of the return of those soldiers from the fort, is fixed by 
Mr. Rendall as the 24th of September : their stay in the Pao de 
Varella is given by Dr. McWilliam as eight days, consequently to 
the 2nd of October ; and Manoel had been three or four days in 
barracks before he was taken ill ; the date of his attack therefore 
was the 6th of October. This man was lodging in the house of 
a publican, during his illness of 1 5 days, and as he had hlacJt 
vomit according to his own account, this remarkable occurrence, 
from the publicity of such an abode, must have been well known 
before Anna Gallinha was taken ill, because recovery within a 
week after such a symptom would be perfectly miraculous. This, 
theu, was one of the first cases, but no one seems to have noticed 
this remarkable circumstance, not even Jamieson, or the pub- 



Inconclusiveness of the Evidence. 



315 



lican Joana. In short, the whole story is improbable, and 
wants corroborative testimony. Barbosa passed through his 
fever in barracks, and was taken ill and went to bed on the 3rd 
of October, but fever did not prevail in barracks until some four 
weeks after, and the first death there, according to Major Mas- 
carenhas, occurred on the 6th of November. Lieut. Santos 
in reply to 491, p. 34, corroborates the Major, by stating that 
nearly all the soldiers were ill on the 24th of November, Barbosa 
likewise says, Luis Briza was ill at the same time he, Barbosa, was ; 
now Briza died on the 12th of November; consequently he 
was ill 40 days before his death, otherwise Barbosa cannot be 
credited. Besides, mortal attacks of Yellow Fever rarely last so 
long. 

I have before pointed out earlier cases of sickness in barracks, 
mentioned in the Report of Dr. Mc William, but no bad results 
having followed at that time, these cases appear to have escaped 
further observation. 

The soldier Alves, in reply to 192, names two men who 
assisted him to bury his comrades who died in the fort ; yet no 
notice is taken of those men, who were some time in the boat 
with, and must have even handled, the corpses. 

Dr. McWilliam says, p. 10, " For it is quite certain that the 
fever did not show itself until (and it is to be marked not until) 
the soldiers came to Beira." Admitted, — but how came it to pass 
that the cases of Perez, and all those already noticed as occurring 
in the house occupied by the officers in Porto Sal Rey, of 
Capt. Estcourt, &c., to be so innocuous up to this time ? 

Dr. King says, Barbosa and Manoel were in Beira 17 days, 
now if this were the case, Anna Gallinha must have been taken 
ill the day they left, and at least one day before Barbosa ; but 
this would not admit of Barbosa's fever standing in the relation 
of cause, to Gallinha's fever as effect ; or in the widest and 
wildest order of causation, the attacks must have been simul- 
taneous ; and this would be an absurdity in most people's view 
of such an event as the transmission of fever from one person to 
another. And what an incubative stage, 10 or 18 days ! 

The statement at p. 42, 43, of Dr. Mc William's Report, given by 
Luis Pathi himself, affords no ground whatever for the assump- 
tion in the last four lines, p. 11, of the Remarks, that he assisted 
in hoisting in the sick, nor is this important piece of information 
to be found in the Report ; * but I have mentioned Joaquim 
Pathi and two others who were so employed. This however, gives 
an air of probability to the further statement, in the first lines of 
p. 12 of the Remarks, as to Pathi's case being a positive instance 
of infection, which is not to be controverted by any number of 
mere negative results." The inconclusiveness of such reason- 

* See Report, pp. 108 and 110, where this case is noticed as an exceptional one of 
infection by fomites. 

y2 



316 Inferences of Dr. Mc William unsatisfactory. 

ing is demonstrated in Poisson's work " Probabilite des Juge- 
mens/* and the formulae are given to determine the probability 
of conclusions a -posteriori. 

In p. 12 of Dr. McWilliam's Remarks, he repeats that Joao 
Chico Fernandez introduced the fever into Estacia, but we find 
Gregorio Zavares in reply to 606, p. 39, of Report, disputing 
this claim with Chico Fernandez, and the reply to 610 would 
seem to throw doubt on Fernandez' being even the second case. 

Dr. McWilliam has recourse to the hypothesis of infection for 
the reason assigned in p. 8 of Remarks, that he " failed to 
discover the least evidence of the cause in the earth, in the 
air, or in anything animate or inanimate on that island, or on 
the small island, unconnected with the ' Eclair/ &c. : " and 
the second conclusion^ p. Ill of Report^ states, ''That although 
there exists in the Island of Boa Yista a physical cause capable 
of producing remittent fever, yet it does not appear that that 
cause was in action when fever broke out in September 1845, 
and that the island was quite healthy when the * Eclair ' arrived 
there."* At the top of p. 9 of Remarks^, however, he says, " By 
the tirne Anna Gallinha was taken ill^j niuch rain had fallen ; 
the weather had become more hot, and, in short, there now (but 
not before this) existed the recognised elements for malarious 
evolution and he might have added with equal truth, " now, 
but not before this," did the fever extend in Porto Sal Rey, 
or indeed anywhere in Boa Vista. At p. 6 of the Remarks, he 
quotes the evidence of Capt. Buckle, of the " Growler," to 
show " a little rain fell once or twice during the night while 
we were there." But does Dr. McWilliam's knowledge of the 
conditions necessary for the production of malaria, enable him 
to decide that this " little " was not enough ? 

Dr. McWilliam's conclusions, given at p. 15 of Remarks,^ 
cannot be said to rest on any probable evidence, still less on 
positive " facts, for he expressly admits, as we have seen, the 
existence of endemial sources of fever, and at the time of Anna 
Gallinha's attack of " the recognised elements for malarious 
evolution." The second conclusion is quite beside the question 
at issue, as malarious fevers are always local, though sometimes 
spreading wider than at others. 

The evidence in support of the third conclusion, instead of 
amounting to proof, is most unsatisfactory; and a large majority 
of those who will carefully examine the testimony must, I pre- 
sume, feel a respect for the judicious reserve of Sir W. Burnett, 
as to the deductions to be drawn therefrom, which few perhaps 
would willingly accord to the late qualified opinion of the Royal 
College of Physicians. 



* On the 21st of August. 



t On the 12th of October. 



Opinion of the Governor- General best founded. 317 



The statement of Mr. Kendall, tlie Consul, at p. 6 of Report, 
proves that clean bills of health were first refused to vessels 
leaving Boa Vista on the 20th of November, — the same day 
the disease was declared to be contagious; nevertheless, it 
does not appear that the want of quarantine had been inju- 
riously felt in any of the neighbouring islands, though restric- 
tions on intercourse had been so beneficial for a time at Fundo 
das Figuieras, as to keep the disease under, though actually 
inside the cordon. The Governor- General and his suite of 60 
Europeans remained in the island up to the 1st of December, 
yet they all escaped so far as has been made known, nor were 
they able to carry the disease along with them, pp. 8 and 1 10. 
The epidemy among the cattle arose from some cause, but, as it 
could scarcely be attributed to a specific contagion communi- 
cated by man, it has not been alluded to in the Report, or 
Remarks. 

The dififerences in the ratio of mortality (p. 94) among the 
dififerent classes of residents were apparently contrary to all pre- 
vious experience in contagious diseases ; for the most opulent and 
best lodged suffered most in proportion ; because they were 
strangers. The mildness of the disease in some villages com- 
pared with its severity in others, would also appear capricious 
in a disease propagated by contagion, and therefore to a great 
extent beyond the influence of locality. Moreover, the evidence 
has been obtained chiefly from the most ignorant classes of the 
population. 

Notwithstanding the conclusion to the contrary in this Report, 
the opinion of the noble-minded Don Jose Miguel de Noronha, 
that the disease " was perfectly endemic," has at least as good 
evidence in its favour as anything adduced on the opposite 
side of the question ; and if his generous philanthropy has 
not been rewarded, for so fearlessly aiding the noble efforts of 
Captain Estcourt to alleviate the sufferings and avert the destruc- 
tion of his crew, it has at least merited some testimony of Eng- 
land's gratitude. 

(Signed) A. B. 



[ 318 ] 



Appendix No. IV. 



NOTICE OF THE PROCEEDINGS OF A BOARD 
OF INQUIRY HELD AT THE OFFICE OF THE 
ARMY MEDICAL DEPARTMENT, 1849-50, ON THE 
NATURE OF YELLOW FEVER. 



A SERIES of questions relative to Yellow Fever having been issued 
from the Privy Council Office, and forwarded through the Horse 
Guards to the Director-General of the Army Medical Depart- 
ment, with directions that a Board of Inquiry should be constituted 
to deliver their opinions on the subject, and such Board having 
been formed accordingly, the General Board of Health at the 
termination of the inquiry, requested to be furnished with a copy 
of the proceedings and evidence taken on this occasion. In reply 
to this request, a copy of the opinion? delivered by the several 
Members of the Board was forwarded from the Horse Guards, 
with an intimation that the evidence might be taken by any officer 
of the General Board who should attend for that purpose at the 
office of the Army Medical Department. 

Some of the documents being very voluminous, the General 
Board instructed one of their clerks on whom they could rely, to 
make a summary of the proceedings and evidence which is here 
given as follows : — 

It appears that the Board consisted of the following Members : — 

Dr. Andrew Smith, Deputy Inspector- General of Hos 

pitals (President), employed as professional Assistant to 

the Director-General.* 
Dr, Thomas Spence, Staff Surgeon, 1st Class, on hospital 

duty at Chatham .f 
John Millar, Esq., Staff Surgeon, 1st Class, previous to the 

assembling of the Board, on the recruiting service at 

Coventry; after the termination of the procedings, at 

Glasgow; and since deceased. 
Dr. Williayn H. Burrell, Staff Surgeon, 1st Class, on the 

recruiting service in London, :j: 
Henry Pilleau, Esq., Staff Surgeon 2nd Class (who acted 

as Secretary to the Board), employed at the office of the 

department under the President. 

* Now Inspector-General, and Superintendent of the Army Medical Depart- 
ment. 

t Now professional assistant to the Superintendent of the Department. 
% Now stationed at Malta. 



Opinions and conclusions of the Board. 



319 



The first proceeding of the Board was to " attentively read and 
examine all official or other documents available, and likely to 
elucidate the subject to be investigated." 

No formal minutes of the procedings were made^ nor was any 
available record kept of the titles of the documents read, but each 
member appears to have taken such notes as he might deem ex- 
pedient. 



The second proceeding was to receive oral evidence of Army 
Medical Officers, and other persons competent to furnish informa- 
tion on the points in question;" but 18 gentlemen only were 
examined, all of whom are Army Medical Officers, viz. : — 



Name. 



Rank. 



Date of Examination. 



Dr. M'Lean 
Dr. Dods . 
Mr. Parry 
Dr. Kelly . 
Dr. DanielL 
Dr. Hawkey 
Mr. Bradford 
Mr. Connell 
Dr. Lloyd . 
Mr. Brown . 
Dr. Jameson 
Dr. Arthur . 
Dr. Millingen 
Dr. Webb . 
Mr. Blakeney 
Sir W. Pym 
Dr. Gillkrest 
Mr. Hugh. Fraser 



Deputy Inspector 

Surgeon 36th Eegiment . . . 
Surgeon, H. P., 4th Foot . . . 
Surgeon, Ordnance Medical Dept. 
Staff Assistant Surgeon 
Staff Surgeon, 1st Class . 
Surgeon 1st Battalion 23rd Fusileers 
Staff Surgeon, 2nd Class . 
Surgeon 36th Regiment, H, P. . 
Surgeon Grenadier Guards . 
Staff' Surgeon, 2nd Class , . . 
Deputy Inspector-General, H. P. 
Surgeon 31st Eegiment . 
Staff Assistant Surgeon . 
Staff Surgeon, 2nd Class . . . 
Inspector General, H. P., &c. 
Inspector General, H. P. . 
Surgeon, H. P., 60th Rifles . . 



Oct. 11, 1849. 
Oct. 18 ,, 
Oct. 31 
Nov. 8 J, 
Jan. 9 1850. 
Jan. 10 , , 
Jan. 11 , , 
Jan. 14 , , 
Jan. 15 & 19, 1850. 
Jan. 16 
Jan. 17 , , 
Jan. 21 
Jan. 22 
Jan. 23 ,, 
Jan. 28 
Jan. 29 , , 
Feb. 5cfsc5. 1850. 
Feb. 12 , , 



After an interval of two months, the opinions of the Board were 
given, preceded by each question separately, as follows — 

" As regards the first question, — 'Is Yellow or Bulam Fever a . 
distinct disease, or only an aggravated form of the marsh or re- 
mittent fever of warm climates f 

The President and three members, viz.. Dr. Spence, Mr. 
Millar, and Mr. Pilleau, are of opinion that the Yellow or Bulam 
Fever is a distinct disease, and not an aggravated form of the 
marsh or remittent fever of warm climates. 

The fourth member. Dr. Burrell, is of opinion that the Yellow 
or Bulam Fever is an aggravated or occasional form of the ordinary 
fevers, continued, remittent, and sometimes intermittent ; is iden- 
tical with these in nature, and causes, and is not more peculiar or 
less indigenous to the latitudes in which it commonly occurs than 
the common continued fever is to this country. 

"As regards the second question, namely — Does one attack of 
Yellow or Bulam Fever give, like small-pox, immunitg from a 
second attack, except in very rare instances f 



320 



Summary of the Oral Evidence adduced. 



The President and one of the members, Mr. Pilleau, consider 
that one attack of Yellow or Bulam Fever does give immunity 
from a second attack, except in rare instances. 

" A second member. Dr. Spence, is of opinion that an attack of 
Yellow or Bulam Fever protects the constitution very greatly from 
liability to a second, but the exact extent requires further obser- 
vation. 

" A third member, Mr. Millar, considers that one attack of 
Yellow or Bulam Fever does give, like small-pox, immunity from 
a second attack, except in very rare instances. 

" And the other member, Dr. Burrell, is of opinion that an 
attack of Yellow or Bulam Fever, like length of residence, enables 
the constitution to resist to a considerable extent a recurrence of 
fever in the same form, but gives little or no protection against 
what he considers other forms of the same disease, or those which 
attack the acclimated. 

" As regards the third question — ' Is Yellow or Bulam Fever a 
contagious diseased 

" The President and two members, Dr. Spence and Mr. Pilleau, 
are of opinion that Yellow or Bulam Fever has frequently mani- 
fested a contagious power ; but that on many occasions the con- 
tagious power, if in existence, could not be detected by the most 
careful observation. 

One member, Mr, Millar, is of opinion that Yellow or Bulam 
Fever is a contagious disease. 

And the other member. Dr. Burrell, considers that nothing 
sufficient has been adduced before this Board to determine affirma- 
tively a question of so much importance to humanity and science, 
and believes the Yellow or Bulam Fever to be absolutely and 
universally non-contagious. 

" As regards the fourth point, namely — 'Is Yellow or Bulam 
Fever capable of being imported f 

" The President and three members. Dr. Spence, Mr. Millar, 
and Mr. Pilleau, are of opinion that Yellow or Bulam Fever is 
capable of being imported. 

The other member. Dr. Burrell, is of opinion that Yellow or 
Bulam Fever is not capable of being imported." 

It may be remarked with regard to the evidence on which the 
first of these opinions was founded, that 

Dr. McLean, although he does not give any answer directly to 
the point, says, among other observations of a similar tendency, 
that he " thinks the same causes that will produce remittent in an 
old resident, will produce Yellow Fever in new residents." 

Mr. Parry " considers the disease in question [Yellow Fever] 
was an aggravated form of the common remittent fever.'' 

Dr. Daniell's opinion does not appear very clearly, but he says, 
"in the remittent fever the skin was generally yellowish." 



Summary of the Oral Evidence adduced. 



321 



Dr. Hawkey says, " I consider Yellow Fever, remittent fever, 
and intermittent fever, only grades of one and the same disease." 

Mr. Bradford says, " fever prevailed during these periods in 
the forms of intermittent and remittent ; and the aggravated form 
of the latter, viz.. Yellow Fever." 

Mr. Connell " had an opportunity of seeing intermittent, re- 
mittent, and mahgnant remittent or Yellow Fever, at several 
stations." 

Dr. Lloyd observes, I call the aggravated form of remittent 
that which exhibits black vomit." 

Dr. Jameson observes, " I consider the three latter [intermittent^ 
remittent, and Yellow Fever] the same fever, only difiering in 
degree." 

Dr. Gillkrest says, " 1 believe the epidemic Yellow Fever of 
Gibraltar, in 18*28, was of the same family as the severe remit- 
tent fever of tropical climates." 

Mr. Hugh Fraser considers '^remittent fever and Yellow Fever 
to belong to the same family of diseases." 

The testimony of two other witnesses, viz., Dr. Dods and 
Mr. Brown, would appear to favour a similar opinion; whilst the 
remaining six only are decided in considering Remittent and Yellow 
Fever lo be distinct diseases. 

With regard to the opinions of the Board on the second question, 
it appears that all parties were agreed as to the fact that Yellow 
Fever, like several other fevers, gives a considerable degree of 
immunity from a second attack, though not an absolute immunity. 

With reference to the third and fourth questions. Dr. McLean 
remarks on the case of the " Crocodile," that " almost all employed 
in the hold and coal-hold were generally attacked with the fever. 
Thinks the Army Medical Officers at Barbados considered it was 
not contagious. Barrack-room where the majority of the cases 
occurred was immediately in the neighbourhood of a drain." 

Dr. Dods, after stating that whilst stationed at Demarara, a 
sailor from Barbados arrived with Yellow Fever, and died in 
the Seamen's Hospital (the disease at the time prevailing in 
the latter island), says, " no case originated in hospital after his 
admission." 

Mr. Parry ascribes the cause of this disease [fever with black 
vomit] to malaria;" and states, that "he never saw any fever 
there [the West Indies] which he considers contagious." 

Dr. Kelly " saw no case [of Yellow Fever] which he could have 
considered to have been produced by any virus emitted from a 
patient labouring under the disease. Does not think there is any 
infectious fever in Jamaica." 

Dr. Daniell states, " no other person in the house I lived, as far 
as I know, suffered from the fever under which I laboured [Yellow 
Fever] at Sierra Leone, either before or after the attack." 



322 



Summary of the Oral Evidence adduced. 



Dr. Hawkey says, " I consider the cause of remittent fever to be 
some exhalation from the earth, at a time when a peculiar state of 
the atmosphere prevails. I believe Yellow Fever depends upon 
the same cause." 

Mr. Bradford says, I consider the disease [Yellow Fever] was 
caused by a local vitiation of the air; the severe cases arose in 
different parts of the barracks at the same time. I never believed, 
from my own observation, that the disease was propagated from 
one person to another." 

Mr. Connell offers no direct opinion, but his testimony may be 
considered as calculated to support non-contagionist views. 

Dr. Lloyd says, " I never knew of any case during my residence 
in the West Indies (15 j-ears) where the Yellow Fever was pro- 
pagated from one person to another. I do not believe that fevers 
arising from palludal or terrestrial sources can become contagious 
under any circumstances." 

Mr. Brown says, " I could not attribute a single case [of Yellow 
Fever] that I saw to contagion." 

Dr. Jameson says, "when black vomit prevailed as an epidemic 
fever at different times, I never remember a single case of a hos- 
pital orderly, or a patient in hospital with any other disease, 
attacked with black vomit fever, except, I think, one or two. I 
have never seen black vomit fever occur above 4,000 feet." 

Dr. Webb says, " I do not think the disease [Yellow Fever] is 
capable of propagating itself by contagion." 

Mr. Blakeney states, the patients with Yellow Fever were 
not isolated from the other patients. I do not recollect any case 
of Yellow Fever originating in the hospital. We never thought 
about contagion. Nor did either men or officers think of con- 
tagion, so far as I know. From my present impressions I should 
not separate Yellow Fever cases from the rest of the patients." 

Dr. Gillkrest says, '■^ all my experience, &c., and the result of 
my deep reflection on the subject, as well as the consideration of 
its history in different parts of the world, go fully to the strongest 
conviction upon my mind of Yellow Fever not being contagious 
under any circumstances whatever." 

Mr. Fraser says, I never saw anything in the epidemic of 
Gibraltar, in 1S28, that led me to believe the disease was conta- 
gious, but the contrary." 

Dr. Millingen's opinion may probably be considered doubtful, 
for he observes, " At that time p. e., in the midst of a Yellow 
Fever epidemic], I did not consider that the disease was conta- 
gious, though now, after reflection, I should not consider myself 
doing my duty if I did not take precautions which at that time I 
did not believe necessary." 

Dr. Arthur, on the other hand, states that " the ordinary or 
marsh remittent fever occurs in all situations where marshes or 
uncleared grounds exist ;" that he never found black vomit, either 



Evidence of Dr. M'Lean. 



323 



before or after death, in cases of remittent fever; and yet after- 
wards (speaking of a severe visitation of " remittent fever," when 
" from 60 to 100 cases were in hospital at the same time)," he 
proceeds, " I recollect some cases on that occasion had hlacJt vomit, 
and one man in particular was taken very ill in hospital, and on 
examination I found on the mattress on which he loas lying marks 
of the Mack vomit, which was Mack vomit from a former patient 
who had died shortly before. I could not account for the aggra- 
vation of disease of this patient, who was apparently getting well 
till this time." 

The ORAL TESTIMONY delivered before the Board was as 
follows : — 

Evidence of Dr. M'-Lean, Deputy Inspector. — October 1 1, 1849. 

Has seen Yellow Fever in Barbados in 1843; in Demerara in 
1843 and 1844. Saw a good many cases at Barbados, which 
occurred among the crew of the troop-ship Crocodile." She 
arrived with a detachment of the 81st from one of the other West 
India Islands — St. Kitts. Troops had landed a month before 
Dr. McLean's arrival, and were under canvass near the old Naval 
Hospital. Does not think that any of the soldiers who landed 
from that vessel had Yellow Fever in camp. At the time of 
Dr. M'Lean's arrival (1st February 1843) the ship's crew, from 
having suffered on board from Yellow Fever, had been landed and 
encamped on the beach, about one-fourth of a mile from the 
garrison. Cases were from time to time admitted from the camp 
into the detachment hospital, which were considered genuine cases 
of Yellow Fever. Black vomit in almost every fatal case preceded 
death. Crew about 120 strong. Thinks about 10 cases out of 
the 120 were admitted from the camp. Cases continued to be 
admitted till about the end of March. Men were not allowed to 
enter the garrison or town. During the time the crew were under 
canvass, some of the sailors were from time to time employed on 
board of the ship, after the ship had been fumigated and other 
wise cleansed. Almost all employed in the hold and coal-hold 
were generally attacked with the fever, and were sent on shore to 
the hospital. Sailors from merchants' service volunteered their 
services to enter the naval service, and worked on board the 
Crocodile " during the day, and passed their nights elsewhere. 
Knows that two of these men were attacked with the fever. Were 
sent on shore to the detachment hospital. The disease had ceased 
to spread in the ship when Dr. M'Lean left the island on the 
22nd or 23rd April. The ship had undergone a second purifica- 
tion, and the coal hold had been cleansed out. Some of the 
officers and men remained on board during the whole period the 
ship was in the bay. Thinks that some of the men, and knows 
that some of the officers, were attacked subsequent to the camp 



324 



Evidence of Dr. McLean. 



being formed on shore. Some believe the disease existed in the 
vessel before the troops bound for Barbados embarked at St. Kitts ; 
others considered it originated after the troops embarked. Un- 
derstood the disease was prevailing at St. Kitts when the troops 
left that island. The surgeon of the ship was of opinion that the 
disease was contagious, and brought on board ship. Thinks the 
army medical officers at Barbados considered it was not con- 
tagious. No Yellow Fever at the time prevailed in the garrison 
or among the civilians. While the men were ill with the fever in 
the hospital, one of the 46th Regiment was attacked in the same 
building, but in a lower story. The surgeon of the regiment 
considered it Yellow Fever. Dr. M'Lean and Dr. Birrell did 
not. About 30 soldiers were at the time in the hospital. The 
soldiers were cautioned not to mix with the sick sailors ; but no 
steps were adopted to prevent intercourse. Convalescent sailors 
were placed in a ward with convalescent soldiers. Dr. Hardy 
attended the sick sailors, and continued healthy. None of the 
orderlies in attendance upon the sick sailors or soldiers, excepting 
the soldier already mentioned, took the disease. Thinks that the 
fever which occurred among the sailors was an aggravated form 
of the remittent fever. Considers the convalescence of Yellow 
Fever protracted. Considers a man recovers more rapidly, and 
is sooner equal for duty, after remittent fever than after Yellow 
Fever. Remittent is more subject to relapses than Yellow Fever. 
Thinks the spleen is more usually affected in the remittent than 
Yellow Fever. In remittent fever the vomiting is bilious. Does 
not recollect ever having seen black vomit ejected from the stomach 
in remittent fever. 

In the early stages of both diseases the fluids vomited are nearly 
the same, with the exception that there is less bile in Yellow 
Fever. Has seen cases of remittent fever equally as severe in 
their symptoms as Yellow Fever, both in the Mediterranean 
and Demerara. Has not seen the fatality in remittent to be so 
great as in Yellow Fever. Never found black vomit in the 
stomach of any of the men who died of remittent. Saw from 30 to 
40 cases in a detachment of the 33rd Regiment at Demerara in 
1843 — 44, a lapse of four months. Cases were principally sent, 
from one end of a particular barrack. Other barracks continued 
free. Were put into separate wards of the hospital, which re- 
ceived all fever cases. Several of the hospital servants were attacked 
with the same disease, but chiefly those employed as cooks. 

Cannot recollect that any patient not in the fever wards was 
attacked. No medical officer attacked. In the deaths that 
occurred black vomit was found in the stomach. There may have 
been at one time 8 or 10 patients labouring under the disease in 
the hospital at the same period. Has known one man die of the 
disease, after he had been walking about and considered con- 
valescent for 10 days- Black vomit was found in the stomach. 



Evidence of Dr. McLean. 



325 



Considered this man on his admission a decided case of Yellow 
Fever. Considers the hospital servants took the disease from 
being occasionally exposed to a more unhealthy locality than the 
other patients who were in hospital, and accommodated in the 
higher parts of the building. Remittent fever was at this time 
prevalent in the garrison. 

In 1844 thinks he had under his charge about 15 patients of 
the 23rd Regiment suffering from Vellow Fever. Nearly all 
were attacked about the same time (say over a month). The 
larger proportion of them was from the barrack which furnished the 
cases of the 33rd Regiment ; still some of them were from other 
rooms. Does not recollect how many died. In all who did die, 
black vomit was found in the stomach. 

Does not think it possible to mistake black vomit for dark 
bile. Hospital orderlies and cooks again attacked ; also some 
patients in hospital : some of them died. From a detachment of 
artillery quartered about one-fourth of a mile from the Line Bar- 
racks, some cases were admitted into the Line Hospital (same). 

At this time several cases of the Yellow Fever occurred among 
the sailors in the bay, and thinks some Portuguese, residents on 
shore, were also attacked. The epidemic of this year was con- 
sidered a limited attack as regards numbers. 

Several of the civil medical practitioners considered the disease 
a distinct one from remittent : others the reverse. There was no 
rumour in August, 1843, when the disease first appeared, that any 
vessel had arrived with any part of the crew labouring under the 
fever. No officer was attacked during the period the disease pre- 
vailed, though they used frequently to go round the hospital with 
the medical officers. Does not recollect any of the patients in 
the 23rd Reo^iment having^ relapses. Convalescence tedious. The 
cases that occurred in hospital occurred from time to time. In 
1843 and 1844 one vessel each year (prizes) v*as brought to 
Demerara, but does not know whether slaves were on board. 
Troops suffered before the sailors. Cases of Yellow Fever with 
black vomit occurred at the same time at Berbice. Was very 
severe there. Two companies of the 33rd Regiment were at 
Berbice. Head-quarters at Demerara. First broke out at 
Berbice. Has never seen a remittent fever in the Mediterranean, 
accompanied by vibices, haemorrhages, &c. 

Thinks the same causes that will produce remittent in an old 
resident will produce Yellow Fever in new residents. Found the 
mucous coat of the stomach in fatal cases of remittent in the 
Mediterranean pulpy and denuded. With the addition of the 
black vomit, thinks the remittent in the Mediterranean would 
approach in appearance Yellow Fever. The morbid appear- 
ances found in the remittent fever of the Mediterranean resemble 
those in Yellow Fever, with the exception that the spleen is more 



326 



Evidence of Dr M'Lean. 



softened in the Mediterranean remittent. Has not met with any- 
old residents in the West Indies attacked with Yellow Fever. 

The prize vessels stated to have been brought in in 1843 and 
1844 were in charge of small men-of-war. Does not recollect the 
crew of these ^vessels to have been sickly. 

Steam communication once a-week between Demerara and 
Berbice. The 33rd Regiment had been about two years in the 
West Indies. The 23rd Regiment had just arrived. The strength 
of the 33rd and 23rd detachments were about the same. The 
barrack-room where the majority of cases occurred was imme- 
diately in the neighbourhood of a drain. The hospital was sur- 
rounded by drains. Rhubarb-coloured livers common in fatal 
cases of remittent in the Mediterranean. Same appearances usual 
in the liver of fatal cases of remittent in Demerara. Does not 
consider there is any difference in the colour of the liver in fatal 
cases of remittent and Yellow Fever. Considers any fever, re- 
mittent or otherwise, may, by undue crowding, bad ventilation, 
&c., produce a fever ; whether the same or not is not prepared to 
sav. At the time the patients in the hospital with other diseases 
were attacked with Yellow Fever, they were in another part of the 
hospital, but might have had communication with those ill with the 
fever, as no measures were adopted to prevent them, except caution. 

Does not think he could, on admission, diagnose in cases between 
remittent and Yellow Fever ; but thinks that before a patient with 
fever is 24 hours in the hospital he could decide whether it was a 
case of remittent or Yellow Fever. In remittent, before this period 
they would show a disposition to remit. In Yellow Fever, re- 
missions, he considers, are not so defined. Did not observe 
remissions in any of the genuine cases of Yellow Fever that were 
admitted into the hospital among the sailors from the Crocodile." 
Some of the cases sent to the hospital from camp were considered 
pure remittent, they having had distinct remissions. 

Never saw black vomit or haemorrhages in the severest form of 
remittent in Walcheren. Never knew a case of Yellow Fever 
terminate in intermittent. A frequent termination of remittent at 
Demerara in intermittent. Instances his own case. 

Does not know, or has not heard, of any instance of Yellow 
Fever having originated in a ship whose hold is supposed to be in 
a filthy condition, or otherwise impure, in any seas, except those of 
the West Indies and A.frica; but thinks he recollects that a naval 
surgeon mentions such an occurrence took place in the Mediter- 
ranean. 

(Signed) C. McLean, 

Deputy Inspector- General. 



Evidence of Dr. Dods. 



327 



Evidence of Dr. Dods, Surgeon, Z^th Regiment. — October 18, 

1849. 

Arrived in Demarara with two companies of the 88th Regiment 
in March, 1847 ; left it on 20th February 1849. Saw biUous 
remittent fever and intermittent during this period. Strength of 
detachment about 170. The tw^o companies above mentioned 
were exactly 12 months in the command, and all, except six or 
seven, suffered from remittent or intermittent during that period; 
about three died. Attacks of remittent were most severe during 
August, September, and October. 

Symptoms then were very high. Vomiting mvariably present. 
Matters ejected from stomach of a dark green ropy appearance. 
Every officer in garrison suffered. Relapses almost invariable. 
Some cases of remittent ran into intermittent. Intermittent in 
some cases, unless checked, ran into remittent. Inhabitants suf- 
iered at the same time. Was considered to be the common 
epidemic fever of the country. ^ 

During the second year of my residence one sailor died of 
Yellow Fever, with black vomit, who had arrived from Barbados, 
where the disease was rao^inof in the o^arrison. Was taken to the 
Seamen's Hospital. No case originated in the hospital after his 
admission. Believes that among the medical men of the colony 
the impression was that Yellow Fever and remittent fever were 
distinct diseases. Vessel was not put in quarantine. 

Two companies of the 66th Regiment relieved the 88th in 
April, 1848. They left Barbados with head quarters of the 
88th, who went on to Trinidad. Yellow Fever had been prevail- 
incr for some time in the 88th at Barbados. The 66th had never 
landed at Barbados, but had been sent on at once to Demerara on 
arrixdng at the W^est Indies. The 66th suffered greatly at 
Demerara from remittent fever and intermittent fever, much more 
severely than the 88th. A man had frequently from 8 to 12 sepa- 
rate attacks. Thinks not more than one of the 66th died from 
any fever. Vomiting was a constant symptom, and always bilious ; 
tinged linen green. In the fatal cases, description of vomiting was 
the same. Every officer, except a surgeon, suffered from lever. 
Five officers were with the detachment. 

The inhabitants suffered this year severely. Portuguese emi- 
grants arrived during the year from Madeira. The Portuguese 
of the colony suffered very severely. The mortality amongst them 
was great. The mortality was occasioned by the common re- 
mittent of the country, not Y^'ellow Fever. 

The women suffered in proportion to the men, also pregnant 
women ; but none of them died. Four under the latter circum- 
stances suffered. Considers marsh malaria was the cause of the 
disease. Has seen patients, while under treatment for other dis- 



328 



Evidence of Surgeon Parry, 



eases, attacked with both remittent and intermittent ; also hospital 
orderlies. Coolies from the East Indies suffered severely from 
remittent and intermittent. Mortality great among them. 

Those who had not regular occupation, or cared for, died in 
great numbers. 

Convalescence after attacks among soldiers was protracted. 

Yellowness of the skin occurred in most of the cases during the 
progress of the disease, but was most marked in second or thud 
attacks. 

(Signed) Geo. Douglas Dods, M.D., 

Surgeon, 36th Regiment. 



Evidence of Surgeon Parry, Half-pay, 4th Foot. — 
OctoherZXst, 1849. 

Ser^d in the West Indies between eight and nine j^ears. Ha 
seen Yellow Fever during that period on two occasions, once at 
Antigua in autumn of 1817, and the second time at Montserrat in 
1821. Prevailed at Antigua as an epidemic, but to limited 
extent at Montserrat. Was in charge of left v/ing of 73rd at 
Antigua, four companies strong. At Montserrat was in charge of 
a detachment of 35th Regiment. Early in autumn, at Antigua, 
the 63rd suffered from a mild form of bilious remittent, which 
became aggravated as the season advanced; about 15 deaths 
occurred, the majority with black vomit. All the men that suf- 
fered had been employed on duty at the dockyard at English 
harbour, and no one was attacked who had not been employed on 
that duty. Is not aware that any fever existed at English harbour 
at the time among the inhabitants there, or persons employed at 
the dockyard. Think there were about 50 military who had no 
communication with the dockyard, and those all escaped. Most 
of the officers who were on duty at the dockyard from time to time 
were attacked. One officer, a new comer, died with black vomit ; 
ascribes the cause of this disease to malaria. Very few people at 
this time were employed at work at the dockyard ; only the 
boatswain and a few blacks lived there. States there were not 
more than three or four whites living in the town; the inhabitants 
were chiefly coloured people. Not a single instance of a person 
in hospital being attacked occurred ; none of the attendants of the 
sick officers were attacked. Considers the disease in question was 
an aggravated form of the common remittent fever. Considers 
an aggravated form to be a disease showing more severe symptoms 
and being more fatal in the result. Has seen a remittent fever 
at Guadaloupe, with symptoms equally severe and of nearly equal 
mortality, without black vomit being so generally present. He 



Evidence of Surgeon Parry. 



329 



thinks it occurred (black vomit) in two cases. Has often seen 
remittent fever in other stations in the West Indies occurring 
without black vomit ever taking place, and many of the cases ter- 
minated fatally. Saw no circumstances on any of those occasions 
that would have led him to believe that one or the other disease 
migrht not have prevailed at the station. 

Believes there are different kinds of fevers in Europe, and that 
these fevers depend upon different causes ; thinks that there are * 
different kinds of fevers in the West Indies, arising from different 
causes. 

Thinks in the West Indies there is simple continued fever,"the 
result of trifling irregularities ; secondly, the remittent fever. 
Considers these two embrace all kinds, and states he never saw 
any fever there which he considers contagious, or bearing any 
analogy to the typhus of Europe. Has never known ulceration of 
the bowels in Yellow Fever. Considers this ulceration of bowels 
a characteristic symptom in typhus. Tongue in Yellow Fever is 
generally clean, and teeth seldom incrusted with sordes. Livid 
blotches on the skin in the fever at Antigua did not occur; but 
yellowness of skin was a frequent symptom. Vomiting first was 
contents of the stomach, with bile ; then (say on second day) a 
glairy fluid would be ejected, the general precursor of black 
vomit. Those that died with black vomit generally expired 
between the third and fifth day. Relapses were frequent ; con- 
valescence was very slow. Few died from the first attack ; the 
fatal cases were generally relapses. 

No marshes in the neighbourhood of English harbour ; no fresh 
troops had joined the detachment for some time previous to the 
outbreak. Dockyard is considered to be a very unhealthy place. 

Disease appeared at Montserrat, in the town, in the person of a 
young lady who was born in the island. She died with black 
vomit. In the same street, midway between these, a young mu- 
latto boy lived; he died with black vomit. This he thinks was 
the second case. About 100 yards distant in the same street a 
Commissary and his family lived ; one of his daughters was about 
the fifth person who was attacked : she died with black vomit. 
In a few days after her death the Commissary was attacked, and 
died in a few days with black vomit. The remainder of the 
family was removed from the town to the barracks in about ten 
days after his death, and on the day after removal the youngest 
daughter was attacked, but recovered. They were placed in a 
house about 200 yards from the barracks. The remainder of the 
family (four in number) escaped the disease. Prior to the elder 
daughter being attacked, three of the black servants were attacked 
with fever; they occupied the ground-floor. About ten days after 
the first case in town the disease appeared in the barracks, but it 
was of short duration, and only one man died. 

z 



330 



Evidence of Surgeon Parry, 



The family of the young lady first attacked consisted of father, 
mother, and five children ; all the children were born in the 
island, also the father : the mother was a native of England. 
Thinks the number of cases amon^ the troops was four or five; 
all these cases were men. They were frequently in the town ; 
none in hospital were attacked. All were men at their duty. 

One of these cases was the barrack-sergeant who died ; black 
vomit appeared previous to death. He had undergone great 
fatigue immediately before the attack. States black vomit to be 
a brown fluid, with black flakes in it, and vomited without any 
effort. Would not have called it black vomit had black flakes not 
been present. Has never seen in any other fevers a dark fluid 
ejected from the stomach which bears any resemblance to black 
vomit. When he arrived in the West Indies he was under an 
impi-ession, from what he had heard and read, that remittent fever 
and Yellow Fever were one and the same disease, and the opinion 
was afterwards confirmed from observation. Has seen remittent 
fever prevailing to considerable extent in localities where he would 
not, a priori, expect marsh miasmata to exist. 

At Bellary, East Indies, remittent fever of a most severe form 
is frequent, and in it, remissions are always very marked, and 
amounting almost to apyrexia, which fever he imputes to marsh 
miasma. This fever never terminated in black vomit; in the 
greater proportion of cases there was no vomiting ; in some it 
occurred. When it did occur, the contents of the stomach and 
bilious fluid were the matter ejected. The cases that occurred at 
a certain period of this epidemic were as severe in their symptoms 
and nearly as fatal as the cases of fever that occurred at A ntigua 
in the 63rd, above alluded to. Those who did not die su fife red 
much from relapses. Considers this the same disease as the 
remittent fever of the West Indies. Has never seen remittent 
fever during his service in New South Wales. Never saw remit- 
tent fever terminate in intermittent in the W^est Indies, but often 
in the East Indies. 

In cases of Yellow Fever, liver was often of fawn colour, and 
enlarged sometimes ; spleen in some cases considerably enlarged. 
Mucous coat of the stomach generally about the great curvature, 
and especially about the pylorus, detached. 

Does not recollect that remissions occurred in the severe form 
of fever, with black vomit, at Antigua. Considers the fevers of 
Bellary and the West Indies only differ from each in the organs 
implicated, that is, the principal lesion in the East being the 
brain, and the chylopoetic viscera in the West. Where the brain 
is much affected in the fevers of the West Indies, there is no black 
vomit. 

Has seen yellowness of the skin in the fevers of the East Indies, 
but is not a common symptom. 



Evidence of Dr. Kelly. 



331 



Disease of the spleen never follows an attack of remittent fever 
at Bellary. 

In fatal cases of ordinary remittent, has not observed the morbid 
lesions to differ materially from those found where the termination 
has been preceded by black vomit. At other times within his 
experience, when the guard was mounting at the dockyard, cases 
of fever were admitted from time to time, but none had black 
vomit. 

Did not separate his fever cases from others in hospital. If 
black vomit does not occur during an epidemic, it is called re- 
mittent ; if it does, it is called Yellow Fever. 

In epidemic Yellow Fever the powers of life seem often com- 
pletely overcome, the patients often having a staggering gait, a 
tremulous tongue, with a very weak pulse. In remittent the inva- 
sion is generally indicated by higher symptoms, the pulse being 
strono- and full. 

Yellow Fever prevailed at St. John's, Antigua, at the same time 
that it prevailed at English harbour. 

(Signed) W. Parry, Surgeon, Half-pay. 



Evidence of Dr. Kelly, Surgeon, Ordnance Medical Department.^ 
November 8th, 1849. 

Served in Jamaica between November, 1835, and February, 
1838. Saw Yellow Fever during this period on more than one 
occasion both in the Royal Artillery and line. Stationed at the 
time at Port Royal. Saw it also frequently in the Royal Naval 
Hospital at Port Royal. Considers it a different disease to the 
usual remittent fever of the island ; thinks he could discriminate, 
at the commencement of the attack, whether the disease was 
remittent or Yellow Fever. 

In Yellow Fever there is a peculiar aspect of the patient, — 
great prostration and an unwillingness on the part of the indi- 
vidual to describe his actual state. In remittent fever the symp- 
toms are more developed; there is decided pain in the head, and 
the patient shows less aversion to explain his condition. In re- 
mittent fever there is generally greater excitement after the inva- 
sion of the attack than in Yellow Fever. In Yellow Fever, ter- 
minating fatally, the yellowness of the skin was usually concomi- 
tant with the black vomit, not before. Yellow Fever generally 
terminated fatally about the fifth day ; occasionally protracted to 
the eighth day. Black vomit appeared to be a fluid resembling 
flocculi, suspended in a dark-coloured serum, — the former, when 
left to settle, falling to the bottom. This was the character of 
the fluid which I denominate black vomit. 

z 2 



332 



Evidence of Dr. Kelly. 



Has never seen an)^ description of dark fluid vomited from the 
stomach in remittent fever. Thinks black vomit sediment to 
consist of effused blood. Thinks the evacuations from the bowels 
in Yellow Fever first consist of biliary fluids and fluids affected in 
colour by medicines, &c. Never knew a person attacked a second 
time with Yellow Fever. The disease generally appeared in the 
morning most frequently after the patient had been on guard at 
night, or when exposed to low temperature; considers this the 
general cause of the disease. Saw no case which he could have 
considered to have been produced by any virus emitted from a 
patient labouring under the disease. Average number of sick in 
hospital from 15 to 20. Never knew any of the sick in hospital 
with other diseases attacked with Yellow Fever. Never knew any 
of the hospital servants attacked. Had two cases of officers 
attacked with the disease; they had coloured servants. Servants 
not attacked. 

At this time nine officers were present with the detachments.* 
The number of patients in Naval Hospital varied usually from 
35 to 40 ; might have seen from 35 to 40 cases of Yellow Fever 
in the Naval Hospital during his period of service at Port Royal ; 
cases there were generally of a serious character. 

Does not think there is any infectious fever in Jamaica. There 
is considerable resemblance in the mode of invasion and progress 
of symptoms of Yellow Fever to the typhus gravior of Europe. 
This resemblance does not exist with respect to remittent fever ; 
but thinks remittent fever may pass into a typhoid form, and saw 
a lady in which he considers this happened. She fell into that 
state after being considered convalescent, and died without black 
vomit. Thinks the evidence of the non-contagious nature of 
Yellow Fever was sufficiently strong to render it unnecessary to 
separate those with that disease from unaffected persons. Clas- 
sified his patients according as they presented one or more of the 
series of symptoms above stated. Thus he had at times cases of 
remittent fever and Yellow Fever admitted within a few days of 
each other. None of the cases classified as Yellow Fever had 
relapses during convalescence ; som.e of those with remittent fever 
had relapses. I'hinks the men who suffered from Yellow Fever 
had been nearly two years in the company ; five of those who 
suffered from remittent' f^'er (three of whom died) men who had 
been sent there for duty, were only lately from England. 

In fatal cases of Yellow Fever, liver was generally of straw 
colour ; otherwise not much affected. Spleen generally enlarged 
and soft ; inner coat of stomach commonly very soft. As regards 
structure, somewhat like wet blotting paper." Near the pyloric 



* Detachments at Port Royal consisted of 1 company of Line and 2 officers 
2 companies of Artillery "vrith 7 officers. , 



Evidence of Dr. Kelly, 



333 



oi"ifice usually vascular ; somet imes in patches, as it intestinal 
effusion had taken place. Black vomit was found in the stomach 
of one who died without having had any previous vomiting, and 
generally in the other fatal cases ; sometimes in only very small 
quantity. 

Tn fatal cases of remittent fever, liver was pale ; not otherwise 
affected. Spleen enlarged, and usual colour. In no case was 
black vomit found in the stomach. Considers the symptoms of 
Yellow Fever owing to the greater depression of the vital powers, 
and to constitute a disease of more aggravated nature than remit- 
tefit fever ; the proportion of deaths was also greater. Observed 
diminution of the severity of the symptoms in Yellow Fever, but 
not to amount to what he considers a remission. In remittent fever 
there was a considerable diminution of the symptoms at certain 
times, followed by a marked exacerbation. 

Served at Bey rout, in Syria, between July 40 and March, 1841 ; 
at which time was stationed there a company of Royal Artillery 
and half a company of Sappers and Miners. Some of them suf- 
fered from slight remittent fever; remissions distinct. Saw an 
artist at Jerusalem die of pure remittent fever. No cases of 
relapses among the soldiers. Skin was not tinged yellow in these 
cases. 

During the three years he was stationed at Port Royal, Yellow 
Fever never occurred as an epidemic, but the cases were sporadic, 
and occurring now and then. Considers the cause of remittent 
and intermittent fever to be marsh miasma. 

During the period the navy was much reduced, the Comus," 
he believes, had several cases of Yellow Fever. Considers that 
the remissions of fatal cases of remittent fever were more marked 
and distinct than in the fatal cases of Yellow Fever. With the 
exception of the black vomit and softening of the mucous mem- 
brane of the stomach and intestines, there are no great morbid 
differences between the two diseases. The duration of fatal cases 
of remittent fever far exceeded those of Yellow Fever. No cases 
of Yellow Fever terminated in remittent fever ; no hoemorrhages 
from gums, &c., occurred in remittent fever. Irritability of 
stomach was greatest in remittent fever, in the early stages. The 
vomiting was bilious in remittent fever; the vomiting in Yellow 
Fever was not accompanied by biliary discharge, but was mucus. 
The vomiting in fatal cases of remittent fever ceased some time 
before death; the reverse took place in Yellow Fever. 

(Signed) William Kelly, Surgeon, 0,M, D. 



334 Dr. DanielVs Evidence on African Fever. 



Evidence of Dr, Daniell. — January ^th, 1850. 

How long did you reside on the western coast of Africa, and 
within what latitudes? — About nine or ten years; and I resided 
between 8° north and 14° south of the line. 

Did you see much of fever during that period? What were the 
kinds of fever, and did it affect all in conamon, or were some con- 
fined to blacks and some to whites ? — Saw a great deal of fever 
during that period, namely, intermittent, remittent, ardent or con- 
tinued, and Yellow Fever. All these fevers were confined to 
whites. 

What was the description of white persons that suffered from 
these fevers? — Traders, resident on shore and board of ship, crews 
of vessels, and missionaries. 

On what occasion did you see Yellow Fever? — On board a 
Danish vessel bound from Sierra Leone to the Gold Coast, near 
Cape Palmas (beheves in 1838). At this time I was on board a 
vessel : I went on board this vessel at the request of the captain 
of the Danish vessel, where I found two men suffering from severe 
fever, stated to have been of continued type. I found that four or 
five had died of fever previous to this period, and was informed 
that in all these cases they had vomited some black fluid, and I 
saw in a basin some of that which had been vomited by the last 
case that died. 

Did you recognize that fluid as similar to any fluid that you 
had seen vomited in any case of fever that had come under your 
observation on the coast ? — No ; I never before had seen any fluid 
like it. The skin, in the two cases I saw, w^as of a tawny hue as 
far as I could discover, the patients being in an obscure part of the 
vessel. They had been sick when I first saw them two or three 
days. Saw them again the same day, prescribed for them, and 
then the vessels parted. The captain and crew w^ere all Danes. 
I continued in good health after having visited these men. I 
believe her crew consisted of about thirteen men. No others but 
the four who died had been attacked during the voyage. The 
captain or mate stated to me that he had had the fever in Sierra 
Leone, and that therefore he was not afraid of being attacked. 
The captain of an English vessel subsequently informed me (which 
had arrived at Fernando Po from the Gold Coast) that the vessel 
above referred to had lost all of her crew except two or three, from 
this fever. 

The ardent fever I saw on the African coast was a continued 
fever, without remissions, of an inflammatory nature. Sailors 
were the most frequent subjects of this fever. The resident 
traders suffered but little from this fever; they suffered chiefly 
from remittent fever or intermittent. The residents on shore, who 
suffered principally from remittent or intermittent, had frequently 
in the same year second attacks of remittent, or sometimes one 



Evidence of Dr. Daniell. 



335 



attack of remittent and one of intermittent. I had three attacks 
of remittent fever in one year, in the Congou province. 

In the low type of remittent fever, the mortality was at least 
eight or nine out of ten attacked. 

On one occasion, at Rio Formosa, three vessels (their crews con- 
sisting of about sixty whites in number) lost the whole number, 
and having obtained second white crews, lost, I think, about one- 
half. This occurred within a period of six months, between August 
and February. The sickly season in that locality is between 
August and October inclusive. 

In a vessel in which I was, out of a crew consisting of nineteen 
whites, including myself, six died; all suffered from the disease 
except one or two. 

The disease in the early stage appeared mild ; commonly about 
the third day it became aggravated^ and then remissions of a few 
hours commenced. The remissions were not preceded by regular 
rigors, but by a sense of cold. I saw and treated the whole of the 
cases on board the vessel on which I was, and also a good number 
on board the other vessels. Vomiting of bile and retching was a 
common symptom of these fevers in the early stages. The remis- 
sions consisted of a marked diminution of the heat, with a slight 
tendency to perspiration ; pulse soft and almost natural ; tongue 
moist ; the patient felt free from oppression and expressed himself 
as feeling much better. In no instance of a fatal case, or any 
case, did I see any fluid vomited from the stomach bear the least 
resemblance to the fluid which was shown to me as having been 
ejected from the stomach of the man referred to as having died on 
board the Danish vessel. I never saw any fluid in these fevers 
vomited which did not appear to me to be bile. Tongue was fre- 
quently black ; at other times morbidly red and dry ; at other 
times the tip and edges red. In the protracted cases, the teeth 
were frequently covered with sordes. The alvine evacuations were 
sometimes dark, sometimes natural ; in the early stages dark 
sometimes, becoming lighter as the disease advanced. Bile was 
distinct in the evacuations towards the conclusion of the disease; 
discharges of blood were frequent from the gums, nose, and anus. 
These discharges from the nose were sometimes profuse and some- 
times small; the same from the gums: in a few cases there were 
discharges of blood from the ears. After these discharges, gene- 
rally speaking, the patients recovered ; relapses frequent ; conva- 
lescence protracted. (Sometimes there were discharges of blood 
from the inner side of the eyelids, in the most fatal cases.) 

I opened the bodies of a great many cases which died. The 
mucous membrane of the stomach in some was congested, either 
generally or in patches, particularly about the pyloric orifice. In 
no case did I find black vomit or any dark fluid ; found nothhig 
but medicine and the nal ural secretions of the stomach. 

The colour of the liver was rather paler than natural; some 



336 



Evidence of Dr, JDanielL 



times larger than natural ; sometimes the ducts engorged with 
bile; gall-bladder generally full of bile; spleen frequently en- 
larged and friable, to wit, easily broken down; blood never tho- 
roughly coagulated when taken from the arm during life. In 
some cases there was suppression of urine, but not generally. In 
the bladder, after death, there was generally a small quantity of 
urine. Death^ when it occurred, was from the seventh to the 
thirteenth day. I cannot say exactly, but I think I have opened 
about 100 bodies. I frequently saw remittent fever terminate in 
intermittent. 

Is not sure whether he ever saw intermittent run into remittent 
fever. 

After recovery from remittent fever, some recovered without any 
visceral disease whatever ; others after recovery had enlargement 
of the spleen. 

In my own case^ I had an attack of remittent fever, and 
recovered perfectly. I then had a second attack, and it left disease 
of the spleen. 

With reference to my observation, taken down by Dr. Burrell, — 

Never saw any one suffering from visceral disease after these 
attacks/' — I meant disease of ]arge or small intestines. Of those 
that remained under my own observation for some considerable 
time after they had recovered, I think (but I am not certain) 
about one-third had disease of the spleen as a sequel. 

I saw remittent fever in Benguela, Angola, Congo district, Ga- 
boon River, Fernando Po, Camaroons River, Old Calabar Bonny 
River, New Calabar River, Brass River, up the Niger, Rio For- 
mosa, Lagos, Weeda, Slave Coast, Gold Coast, Windward Coast, 
at the Gambia, and Sierra Leone. 

W^hen I went on board the Danish ship, I was there altogether 
during the two visits about an hour and a half, but I did not con- 
tract the fever. About two months previously I had a fever at 
Sierra Leone, which I was informed by Dr. Ferguson, who 
attended me, was Yellow Fever. I had been on shore at Sierra 
Leone from Liverpool about two weeks before I was attacked. I 
did not see any cases of Yellow Fever at this time. 

I do not consider that black vomit should always be present in 
Yellow Fever. 

The duration of ardent fever was from seven to fifteen days. 

In the low remittent fever there were always remissions. Suc- 
ceeding the remission on the third day was an exacerbation. 

None of the crew of m}^ own vessels were attacked with remittent 
fever while at sea ; but on getting within the rivers, close to shore, 
or going on shore, they were attacked. 

Never heard of Yellow Fever appearing in any vessel on the 
coast which had arrived with her crew in a healthy condition. No 
other person in the house I lived in, as far as I know, suffered from 
the fever under which I laboured at Sierra Leone, either before 



Evidence of Dr. Hawkey, 



337 



or after the attack ; nor had I, as far as I know, been near any- 
body with the fever. I suffered in June. 

I was in the constant habit of going about the town. 

In the remittent fever the skin was generally yellowish. 

(Signed) William F. Daniell, M.D. 

Staff Assistant- Surgeon. 



Evidence of Dr. Hawkey, Staff Surgeon, \st Class. 
January iOt/i, 1850. 

Served in Jamaica, St. Lucia, and Barbados, as a Staff Sur- 
geon, first class, altogether nearly six years. Occasionally saw 
during this period ephemeral fevers, from usual irregularities, 
without general or local yellowness of skin. On all occasions 
when I witnessed Yellow Fever prevailing at Jamaica (where I 
only saw Yellow Fever prevalent to any great extent), there also 
prevailed the common remittent fever, I consider a fever to be 
remittent fever when there are periodical abatements of the vio- 
lence of the symptoms, lasting for a longer or shorter period. 

I have never seen any case of fever in the West Indies which I 
consider a continued fever. So far as my experience goes, the 
fevers 1 saw in the West Indies, the result of irregularities, pre- 
sented remissions. In many instances 1 saw fevers, which were 
extremely mild in their commencement, terminate in Yellow 
Fever ; but I considered these fevers Yellow Fevers from the 
commencement. 

In Yellow Fever it was difficult to decide whether the abate- 
ment of the symptoms amounted to a remission; in ordinary 
remittent fever the remissions were distinct. Observed, during the 
prevalence of Yellow Fever, cases of remittent fever prove fatal 
without the disease changing its character. Yellow Fever was in 
many cases mild at the commencement, and, when it became 
aggravated, an abatement of the symptoms was observed in some 
cases; others terminated fatally, without any abatement of the 
symptoms. I have seen cases of what I consider genuine remit- 
tent fever, take on during their progress the character of Yellow 
Fever. 

The liver was of a nutmeg colour, in the fatal cases from remit- 
tent fever. 

The mucous membrane of the stomach was thickened in some 
cases ; in others, abraded and softened. Never saw black vomit 
in the stomach of such cases. Does not recollect any peculiarity of 
the spleen, In Yellow Fever the morbid appearances were much 
the same, with the exception that black vomit was contained in 
the stomachs of most of them. 

In Yellow Fever at Jamaica, when death ensued, it generally 
took place between the third and seventh day. 



338 



Evidence of Surgeon Bradford. 



I have seen persons suffer at least twice from the regular remit- 
tent fever. 

I think I recollect persons suffering- from Yellow Fever who had 
suffered from remittent fever on some previous occasion. 

I consider the cause of remittent fever to be some exhalation 
from the earth, at a time when a peculiar state of the atmosphere 
prevails. From what I have heard and read, I believe Yellow- 
Fever depends upon the same cause. 

I believe that in a small room, with want of proper ventilation, 
and crowded with persons labouring under Yellow Fever in an 
aggravated form, that a healthy person, breathing the atmosphere 
of the room for some time, might contract the disease (Yellow 
Fever). 

I consider that under such circumstances the atmosphere is 
morbidly polluted by the bodies of the sick, which pollution creates 
the same disease as that under which the sick laboured. 

I consider Yellow Fever, remittent fever, and intermittent fever, 
only grades of one and the same disease. 

I have seen cases of Yellow Fever die, without any traces of 
black vomit. 

I know of no disease^ except under the general term of conta- 
gious diseases, that give an immunity from second attacks, except 
in rare instances. 

I have never seen intermittent fevers (the lowest grade of Yellow 
Fever, according to my opinion) arise in Barbados among white 
persons. 

I cannot account why the aggravated form should occur when 
the lower form did not occur. My experience of Barbados is con- 
fined to a few months. 

In mild cases, when no epidemic Yellow Fever prevails, I think 
I could diagnose a case of Yellow Fever, if it were to occur. I 
would chiefly depend upon the peculiar expression of the counte- 
nance, and the hoUowness of the eyes. 

If a man should come into hospital after a debauch, with head- 
ache, hot skin, vomiting, suffused eyes, and pains in the bones, I 
think t could distinguish this case from Yellow Fever. The ex- 
pression of the countenance of such a man would be very different 
from that of a man labouring under Yellow Fever. But there are 
cases of Yellow Fever where this peculiarity does not occur at the 
onset. 

(Signed) Wm. Hawkey, M.D. 

Staff Surgeon, 



Evidence of Surgeon Bradford^ \st Battalion 2^rd Fusileers, 

January Wth, 1850. 
I served in Jamaica, as a regimental medical officer, during five 
years and seven months, and in Barbados, Trinidad, and Antigua 



Evidence of Surgeon Bradford. 



339 



for three years and five months. During these periods I saw 
Yellow Fever on a large scale, on many occasions. Fever pre- 
vailed, during these periods, in the form of intermittent and re- 
mittent, and the aggravated form of the latter, viz., Yellow Fever. 
I also saw fevers arising from irregularity. These latter were of 
a continued type. All the fevers, except the latter, that I saw, 
exhibited either remissions or a tendency to them, except in cases 
of extreme intensity. 

I would characterize remission to be an abatement of heat, of 
general sufferingr of delirium, and a diminution of the force and 
frequency of the pulse, lasting from three to twelve hours. 

In severe cases of the aggravated form, or Yellow Fever, if the 
patient lived for three or four days after admission, it has seldom 
or never occurred that I have not observed at intervals a remission, 
as above described, more or less complete. 

In warm climates, the abatement of symptoms is much more 
remarkable than in the fevers of cold climates ; the sinking, cold 
extremities, and cold clammy sweats, which are so apt to appear 
in the fevers of hot climates, and even in the most robust frames, 
are remarkably distinctive from the abatement of symptoms which 
occurs in the fevers of cold climates. After the abatement of 
symptoms above described in warm climates, the symptoms of 
excitement again take place. I have frequently heard patients, 
during the abatement above described, express themselves so much 
relieved as to deny they were ill. 

I have often seen what is styled remittent fever prevailing, when 
the aggravated form, called Yellow Fever, did not occur. Some 
of these cases proved fatal, though rarely without exhibiting the 
symptoms of the aggravated form above described. 

The morbid appearances of these cases were — the vessels of the 
stomach congested ; the mucous coat but little changed ; the sto- 
mach found to contain the ordinary fluids recently swallowed, or 
secreted, slightly tinged with bile ; the liver appeared to contain 
more blood than in its natural state, its structure and size un- 
changed, nor have I observed any marked change in its colour; 
bile in the gall-bladder has become like the viscid pulp of some 
fruit ; spleen, generally speaking, was softer, from its containing 
more blood, and was, therefore, easily broken. 

I think I have examined eight or ten such cases, and seen many 
others examined. In all of them the above were the morbid 
appearances. I have often seen cases of what is called remittent 
fever terminate in intermittent. I have also seen cases of inter- 
mittent terminate in remittent. I have seen cases of intermittent 
fever terminate fatally. In these cases the morbid appearances 
after death were similar to the cases of remittent, above described. 
In intermittent fever I have seen sallowness of skin, but not 
amounting to intense yellowness. In the remittent fever the 
sallowness was not so common as in intermittent, but I have seen 



340 



Evidence of Surgeon Bradford. 



it in both, but not the intense yellow that occurs in the aggravated 
form of remittent fever (Yellow Fever). 

I have seldom seen organic visceral complaints follow fevers in 
the West Indies. In the ordinary remittent, convalescence was 
comparatively rapid. The morbid appearances in the aggravated 
form (Yellow Fever), were intense congestion of the vessels of the 
stomach, duodenum, and even jejunum, causing their internal coat 
to appear of a deep crimson colour ; mucous coat softened, but not 
from the effect of the disease ; the congestion was chiefly at the 
cardiac extremity ; no appearance of abrasion or loss of substance 
of any kind. In the majority of cases, the contents were similar to 
those I have described as being found in fatal cases of remittent 
fever ; but in about a fourth there was an inky fluids, constituting 
the black vomit; this fluid I have seen in duodenum and jejunum. 
I have found as much as a pint or a pint and a half, but generally 
the quantity was smaller. The black vomit was a uniform fluid, 
like a mixture of ink or soot and water, but I never minutely- 
examined it, to ascertain its exact nature. It remained, after 
standing, of a uniform colour. The liver contained more blood 
than when in a healthy state, more particularly the branches of 
the vena portae. Its structure w^as not materially changed ; its 
^ size was generally rather increased ; its surface colour not altered 
materially, nor when cut into did I observe any alteration in 
colour. I have seldom seen a case of fever admitted into hospital 
which was considered by me, at the period of admission and for 
some days afterwards, the ordinary remittent, assume subsequently 
the symptoms of the aggravated form (Yellow Fever). 

The cases of the ordinary remittent fever proved fatal most fre- 
quently on the ninth, tenth, or eleventh day ; in the cases of the 
aggravated form, death occurred generally on the fourth, fifth, or 
sixth day. During epidemics, the cases of the aggravated form 
(Yellow Fever) were generally admitted from certain localities of 
barracks, such as the portion occupied by a particular company, 
or a particular building, as in the case of oflacers and married 
people. At such times, the fever cases admitted from other 
localities exhibited the character of the ordinary remittent. I 
never could detect any reason, either in the locality itself, or in the 
state of matters around it, to account for this difference. 

The married people were generally located in inferior buildings; 
these buildings were commonly huts within the enclosure; the 
surface drains ran nearer to them, but I never saw anythmg 
offensive in these drains. Thinks the rooms were generally- 
crowded, and not so well ventilated during the night as the ordi- 
nary barrack rooms. The severe cases among the soldiers came 
generally from the lower floor, which is situated on arches, on an 
average, elevated at least 4 feet from the ground. I think the 
huts furnished a greater proportion of cases of the disease than the 
lower barrack rooms. The officers who suffered, within my know 



Evidence of Surgeon Bradford. 



341 



ledge, in Jamaica, were generally living in upper rooms; the 
worst cases (three) among them came from one of the field officers' 
quarters at Up Park Camp. In this quarter there were no open 
drains, no want of ventilation, or any assignable reason why the 
disease should have occurred. The same appUes to the quarters 
of the other officers. 

I consider the disease was caused by a local vitiation of the air. 
The severe cases arose in different parts of the barracks at the 
same time. I never believed, from my own observation, that the 
disease was propagated from one person to another. I did not 
observe that when once it appeared in a barrack room it spread to 
any great extent in that room. 

At Up Park Camp, while the disease prevailed there in 1832, 
out of 555 men, 319 were attacked, and 43 died; of these 
43 the whole did not die from the aggravated form, but the 
majority did. The aggravated form appeared, chiefly, in July 
and August. 

After the disease had ceased in the portion of the 56th 
Regiment at Up Park Camp, a company of the regiment was 
brought into camp from Kingston, and was attacked with the 
disease ('about one-fourth of the number); many of them died, 
and the disease was of an aggravated form. 

The disease in an aggravated form at Up Park Camp ceased 
in August, and the company arrived from Kingston in either the 
last week in November or first week in December. In this interval 
some ordinary cases of remittent occurred at Up Park Camp. 

I have frequently seen repeated attacks of the ordinary remittent 
in the same individual; I have seen the same as regards inter- 
mittent, but more frequently than in remittent. I have known 
persons suffer from the ordinary remittent who have suffered from 
the aggravated form (Yellow Fever). I have known persons 
suffer from the aggravated form of the disease a second time, with 
symptoms similar to the first attack. I know two such instances — 
Hunt, a musician, and Houtoway. With reference to Hunt, his 
first attack occurred in July or August, the other late in the year 
(say December) ; it was during the time when the company from 
Kingston was suffering from disease. 

I think persons who had suffered from the malignant form were 
very much less liable to second attacks of the malignant form than 
those who had suffered from ordinary remittent were to second 
attacks of the latter disease. 

At the time the disease, in its aggravated form, commenced in 
1832, several patients, who had been admitted into hospital prior 
to the disease appearing in the barracks (one I may mention, a 
fractured clavicle), were attacked with the fever in an aggravated 
form, and died. At this time the sick hst was about 26. Two of 
the hospital attendants, at least, contracted the same disease, and 
died of it. There were three medical officers doing duty; none of 



342 



Evidence of Surgeon Bradford, 



them were attacked. None of the officers (in 1832) nor their 
famihes suffered from any description of fever. I have seen inter- 
mittent and remittent fever occur in situations where there was no 
swamp ; but these diseases are more common where there are 
swamps. At Falmouth, which has swamps on three sides, inter- 
mittent and remittent were rare. I was there a year. 

The swamp is partly supplied by sea, and partly by rivers or 
water from the surface of the earth. I never observed intermittent 
to originate at Up Park Camp. 

I consider the reason why we did not experience the lowest 
grade of fever, viz., intermittent, was that the cause was sufficiently 
powerful to produce the more aggravated forms ; and I account 
for the ordinary remittent and the very aggravated form (Yellow 
Fever) having both occurred at the time, to the circumstance of 
the different susceptibility of individuals. I ascribe the complete 
exemption of some to the same circumstance — a lesser suscepti- 
bility. 

During the existence of the epidemic of 1832, cases of fever 
were admitted arising from ordinary irregularities, and designated 
as common continued fever. Some of those cases, while in hos- 
pital, assumed the aggravated form. 

I was at Trinidad (1844, 1845, and 1846) for 15 months, with 
three companies, during this period. Saw no case of the aggra- 
vated form (Yellow Fever). I think about 130 or 140 cases 
occurred of the ordinary remittent. 

I was in Barbados first 13 months, and subsequently three 
months, in 1844 and 1847. In the month of August, 1844, a 
mild remittent prevailed, with decided remissions. All the cases, 
men and officers, showed a tendency to remit. Had no case of 
intermittent during this period, except those brought from Deme- 
rara. I am of opinion the cause that existed there was not suf- 
ficient to produce the aggravated form ; but I cannot account why 
it did not produce the intermittent. 

In fatal cases, after a first attack of the ordinary remittent, I 
have not observed disease of the spleen; but my attention was not 
specially directed to the inquiry. 

I do not know any diagnostic mark between ordinary remittent 
and aggravated remittent (Yellow Fever), before a certain stage of 
the disease. 

I very rarely saw black vomit ejected from the stomach during 
life. 

I consider the vomiting in Yellow Fever is greater in the early 
state than in remittent. The yellowness of skin in Yellow Fever 
is deeper than in I'emittent. I have never seen passive haemorrhage 
in the ordinary remittent, but I have in the aggravated grade 
(Yellow Fever). 

I was quartered at Chappleton, Jamaica, in July 1833, with a 
detachment of 90 men and 4 officers, with some white women and 



Evidence of Staff- Surgeon ConnelL 



343 



children and black sers'ants. Fever of the most malignant remit- 
tent form, without black vomit in any case before deaths and with 
occasional deep intense yellowness of skin and marked remissions, 
broke out about three weeks after arrival, and attacked every indi- 
vidual except one. Fourteen men and one woman died between 
4J months : the party was then removed. No marshes existed in 
the neighbourhood, but it rained at least 83 days. 

No idiopathic case of intermittent occurred, but it was a fre- 
quent sequel of remittent. The civil population suffered all round 
us. Several managers of estates in the neighbourhood died. The 
civilians considered such an occurrence as a fever of this description 
uncommon. The black servants of the officers suffered from the 
same disease. Several had severe attacks, but none died. When 
relapses occurred, they were of intermittent form. 

The fever I saw there was as severe as the malignant form of 
fever at Up Park Camp, with the exceptions that the stomach 
was not so excessively irritable, and that black vomit did not 
occur. 

On the removal of the detachment to Port Hoyal^ the disease 
ceased immediately. The company that relieved us at Chappleton 
was attacked, but removed before any serious consequences ensued. 

Chappleton is distant from the nearest point of the sea-coast 
about 18 or 20 miles, and I suppose it to be from 1,000 to 1,200 
feet above the level of the sea. 

(Signed) Edw. Bradford, 

Surgeon, 2'Srd Fusileers. 



Evidence of Staff- Surgeon {'2nd Class) Connell. — January 14_, 

1850. 

I served in the Windward and Leward Islands seven years, 
from October 1841, to September 1848. Dm-ing this period I 
was in Dominica from December 1841 to April 1844. After that 
I was about two years in Demerara, and eight months in Barbados, 
1846 ; then in Grenada from September 1846 to September 1848. 

During this period I had an opportunity of seeing intermittent, 
remittent, and malignant-remittent, or Yellow Fever, at all of 
these stations. By a remission I mean an abatement of the fever, 
the vascular action reduced, head-ache less, heat reduced, and the 
patient expressing himself as feeling more comfortable. 

These remissions vary in duration. I would call the abatements 
of the common continued fevers in this country remissions, as they 
resemble the remissions of the fevers in the West Indies. I think 
I have seen about 10 or 12 cases of the malionant remittent fever 
prove fatal, and had an opportunity of examining them after death 
I found black vomit generally in the stomachs of these cases. 
The mucous membrane was generally softened. The livers on 



344 



Evidence of Staff- Surgeon Connell. 



convex surface were sometimes of natural colour, and sometimes 
of mottled marbled appearance, like blue and white or Castile soap. 

I think during the year 1844, at Demerara, I saw three or four 
deaths from malignant remittent fever in one week, out of a strength 
of about 19 whites. I saw a case of fever in Barbados in 1846, 
in a man of the 7th Fusileers, which I considered was Yellow 
Fever — it was treated as simple continued fever. Assistant- 
Surgeon Collings treated the case, and watched the case closely, 
but could not discover any remission ; so far as the symptoms 
were concerned, it appeared to me a continued fever. The fever 
had existed about two days when I saw the patient. He died the 
same night or the next morning. Had no vomiting before death 
of any kind, nor was the skin yellow. I was present at the post- 
mortem, and black vomit was found in the stomach after death. 
Dr. Davy was present, and desired that the black vomit should be 
tested ; the quantity was about half a pint ; colour was like that 
of coffee-grounds. There was no other similar case at that time. 
I consider that calomel and quinine are equally efficacious as a 
remedial agent in the malignant remittent as in the ordinary re- 
mittent. I am of opinion that I could distinguish the remittent 
fever from all other fevers by a peculiar heat of skin ; by other 
fevers I mean continued and intermittent. 

I consider in 1847 an epidemic remittent fever prevailed at 
Grenada when I was there. It was a common occurrence for 
remittent fever to terminate in intermittent. I never saw inter- 
mittent fever take on the remittent form of fever. I consider all 
the cases of idiopathic fever that I saw in the West Indies, whether 
from the usual irregularities of soldiers or otherwise, were remittent 
fevers. 

In all my practice of remittent fever from the period of Dr. 
McLean's illness, I adopted one uniform treatment. I used the 
same treatment, viz., calomel and quinine, in cases coming into 
hospital from the usual irregularities of soldiers. I consider Dr. 
M 'Lean's case was the ordinary remittent. In the severe remittent^ 
remissions and exacerbations in many cases occurred clearly ; in 
others the disease appeared to cease with the first remission. In 
the fatal cases of malignant remittent fever, the remissions were 
generally less distinct than in others. 

I have seen many cases where I could not see a remission. In 
the malignant fatal cases of remittent fever, death usually occurred 
on an average about the third day. In all the fatal cases that I 
saw, amounting to about 12, the remissions were very indistinct, 
if at all manifested. 

I have not noticed disease of the liver or spleen to be a con- 
sequence of attacks of remittent fever. 

I have never seen an instance of a second attack of the malig- 
nant form of remittent fever. From the ordinary remittent I have 
seen second attacks in the same individual, or even a third. 



Evidence of Dr. Lloyd. 



345 



I do not think the first attack of remittent fever increases the 
susceptibility to subsequent attacks. 

Convalescence from* malignant remittent fever was slov/. In 
the ordinar}' remittent fever convalescence was quick. 

I have not seen any man who had suffered several attacks of the 
ordinary remittent, suffer subsequently from the malignant form 
of it ; it is not uncommon for a man who has suffered from the 
malignant form to have an attack of the intermittent or ordinary 
remittent. It was an opinion generally prevalent in tlie West 
Indies among the non-professional people^ that one attack of 
Yellow Fever was a kind of protection from a second attack. 

I do not recollect ever havinor had any private conversation with 
medical men on this subject. I never knew any soldier or civilian 
liaving had a second attack of Yellow Fever. As far as my obser- 
vation goes, tlie wliite Creoles suffered from remittent and inter- 
mittent fever. The black soldiers suffered principally from com- 
mon continued fever, and occasionall}^ ague. I recollect having 
seen one case of epistaxis in a case of remittent fever ; I heard of 
SGMie others. These cases recovered. The remissions did not 
take place at any particular hour of the day. 

I consider simple residence in the West Indies lessens suscepti- 
bility to fever of any kind. Never knew a case of black vomit 
but in Europeans. Remittent fever is a very rare occurrence in 
an African soldier. I think I know of one case. 

I do not recollect having seen in any of the cases that proved 
fata], passive hsemorrhages. 

I have known patients or orderlies attacked in hospital with 
severe remittent iVver, after casrs with that disease had been ad- 
mitted into hospital. This took place at the time w-hen the tliree 
patients above referred to died in one week. One of the three 
that died was a man in attendance on the other two, sent for tha 
particular purpose. 

I do not recollect any of the other patients or orderlies 
were attacked at that time. Tiie three men who died were 
artillery men, and we had scarcely any persons in hospital at the 
time but blacks. 

(Signed) James Conkell, 

Staff Surgeon, 2nd Class. 



Evidence of Dr. Lloyd, HaJf-jmy Surgeon, 36th Begiment. — 
January 15, 1850. 

I served upwards of 15 years in the West Indies, rather more 
than four years in Jamaica^ and the remainder in the Windward 
and Leeward Islands. 

During this period I have seen remittent fever in two forms, 
viz., the aggravated, and protracted remittent, the intermittent, and 



346 



Evidence of Dr. Lloyd. 



symptomatic fever, by which I mean a fever arising from irregu- 
larity of any kind. I class Yellow Fever under the head of 
aggravated and protracted remittent. I have seen from 1,300 to 
IjSOO cases of the protracted form of fever. The general symp- 
toms were preceded by short and repeated rigors, sense of lassi- 
tmde and weariness of limbs, headache, nausea, sometimes amount- 
ing to vomiting ; increased temperature of the skin, and in young 
soldiers fulness of pulse, violent action of the carotid and temporal 
arteries, flushed countenance, dryness of the mouth and fauces, 
pain of the loins, occasionally alcernating with frontal headache ; 
the latter symptoms amounting to excruciating pain of the loins 
and forehead. These symptoms appeared in an increased form 
the following day, attended in some instances with considerable 
gastric irritation, characterized on the 3rd or 4th day by coM'ee 
ground vomiting, preceded in some instances by bilious vomiting, 
iM the protracted form, and in the aggravated form by black 
Tomit; the latter never preceded by bilious vomiting ; in the pro- 
gress of the disease, slight remissions at times only were to oe 
discovered by a very acute observer. These remissions were 
characterized by the heat being diminished, and the skin becoming 
slightly moist, and tongue also, which in many instances exhibited 
the appearance of uncooked beef-steak, accompanied by a slight 
degree of moisture of fauces. The pulse became more regular 
and soft, the abatement of symptoms in many instances was very 
indistinct; but when it did occur, generally took place in the 
evening, and at irregular periods. I call the abatements that take 
place in the common continued fever of this country', remissions, 
on the same principle as above stated ; these remissions varied 
from half an hour to two hours ; after these remissions, consider- 
able prostration of strength usually occurred, with increased gastric 
irritation, sometimes ending in vomiting. When black vomit 
occurred, the fluid ejected from the stomach resembled tar in a 
liquid state, imparting an indelible stain to linen or clothes of a 
greenish black hue ; this fluid is ejected violently from the stomach 
in the form of a segment, to the distance of several yards. The 
coff"ee-ground vomit when it occurred, appeared to be ejected in 
most instances by the action of the stomach alone in large quan- 
tities, and not by any jerking of this organ ; the stain of this vomit 
could readily be removed by washing. In some instances there 
was a slight yellowness of tunicse adnatae, and towards the back 
part of the neck in this form of fever becoming more general after- 
wards, but not invariably; considered by me to be disorganized 
blood combined with bile. The coffee-ground vomit is a some- 
thing held in solution by a fluid which, when allowed to stand, 
settles to the bottom ; this sediment consists of a resinous-like matter, 
tinged with mucus. The black vomit is disorganized fibrin, 
mixed with bile; the black vomit cases all terminated fatally, in 
the majority on the 4th day; the coffee-ground cases were some- 



Evidence cf Dr. Lloyd. 



347 



times protracted to the SSrd day. During this period gastric 
irritation was constantly present, but not always attended with 
cofFee-ground vomit, unless the hand was pressed roughly over the 
epigastrium, when that result invariably ensued. From the 3rd 
to the 1 1th day at certain intervals the cofFee-ground vomiting 
occurred ; after the 11th day all the symptoms of fever continued, 
but I do not recollect further vomiting, though nausea often 
occurred. Remissions in all these cases occurred at some period 
of the 24 hours duringr the whole continuance of the disease. In 
the black vomit cases when examined after death, the stomach 
towards its inferior fundus was coated with a dark tenacious fluid 
mixed with mucus, and when carefully removed I could notice 
dark patches, ecchymosis, and numerous black points; and without 
the aid of a lens, erosions and minute rupture of the venous coats 
were to be seen, the arteries appeared to be apparently empty 
and not ranch altered in structure; the mucous membrane was 
thickened with partial and ecchymosed patches of a red colour, 
varying in size from a fourpenny piece to a sixpence. In these 
cases the stomach was generally found contracted ; sometimes I 
found a small portion of bile from regurgitation, but no other 
fluid. In most instances the large intestines were inflated, the 
mucous membrane not in an abnormal state, the feculent matter 
sometimes of an ash-colour, greyish, and in no instance assuming 
the colour of gingerbread ; occasionally of a very dark colour. 
The liver, generally had a diminution of blood in quantity, except- 
ing the portal system, where the blood was generally of a dark 
colour, its size varying much. In the protracted form of fever 
which I have often seen at St. Lucia, the liver was soft, disor- 
ganized, and of a dark mottled colour, weighing in some instances 
(drunkards) 12 lbs. Surface often the buff orange of syme, varied 
with cream-yellow j frequently mottled with these two colours, 
and could be traced when cut into throughout its subtsance ; ifs 
structure friable and greasy. The spleen in the majority of cases 
was like black-currant jelly, perfectly disorganized, and easily 
broken down with the fingers. I have occasionally seen cases of 
cofFee-ground vomiting terminate fatally, these were of the pro- 
tracted form of attack. In these cases, when examined after 
death, there was an apparent injection of the vessels of the mucous 
membrane, exhibiting in partial patches redness and ecchymosis ; 
the contents of the stomach sometimes fluid, occasionally empty; 
generally the fluid was some drink taken into the stomach a short 
time before death, and sometimes coffee-ground vomit, but never 
to any great amount. Mucous membrane covered by a tenacious 
mucus, sometimes of a slight reddish colour. In no'instance was 
there erosion or rupture of blood-vessf Is. Liver, generally speak- 
ing, on its surface was of a light yellowish-brown colour, mottled 
with bluish green ; this colour was generally confined to its 
external surface. On cutting into it the portal vessels were filled 

2 A 2 



34S 



Evidence of Dr. Lloyd. 



with dark blood, its structure of a greyish yellow (Syme yellow) 
varying in intensity. In all the cases that came under my obser- 
vation of the coffee-ground form, they for the most part terminated 
in the intermittent character, mostly influenced by locality. I 
never knew any cases of the aggravated form terminate in this 
manner, all beino- fatal. I call the aoforravated form of remittent 
that which exhibits black vomit ; the protracted that where the 
cofFee-ground vomit occurs in its course. At Berbice I have seen 
in the 65th Regiment at least 300 cases of remittent fever, which 
did not exhibit as a symptom the cofFee-ground vomit. The 
regiment consisted of about 700 men, and the disease was so 
general that there was not a sufficient number of men (^healthy) to 
mount a sergeant's guard. This occurred in the months of 
November and December, 1830. Every officer was attacked 
except myself and one other; I never met a case of coffee-ground 
vomit here; the regiment suffered much in that fever, the fluid 
vomited beings vitiated bile, and I think about 15 died. In those 
that died, on dissection patches of ecchymosis were found on the 
muco?is membrane of the stomach, a quantity of thickened mucus, 
slightly 3^ellowish, adhering to the mucous surface of the stomach ; 
no fluid was found except; what the patient had taken into the 
stomach. Liver enlai'gecl, for the most part friable; extremely 
unctuous and greasy. Colour between deep reddish-orange to 
brownish-orange ; structure dense, but easily broken down ; spleen 
in most cases small, bluish, and firm. All these cases occurred 
in barracks. None of the patients in hospital labouring under 
other diseases were attacked, but I recollect one Orderly suffered 
vvho had been greatly fatigued. We had black nurses ; none of 
them were taken ill. At this time there was no fever of this kind 
in the town ; these cases, with scarcely an exception, terminated in 
intermittent fever, and the intermittents were of a protracted form, 
few recovered perfectly until removed from the locality. I attri- 
bute this fever to marsh miasma. I do not recollect any of those 
cases to have had a relapse into the remittent form. I consider 
the cause of the aggravated form of remittent fever to be a highly 
malarious condition of the atmosphere acting as a deadly poison 
on the nervous system ; and I consider this malarious condition 
can be at times circumscribed to a limited space, and continue so 
circumscribed, notwithstanding the prevalence of high winds — I 
mean in low swampy situations, f never saw a case of a man 
labouring under any oilier disease in hospital, attacked with the 
aggravated form of remittent fever, where patients in the same 
ward were suffering from it under treatment in hospital ; but I 
separated such cases, ulcers, &c., into other wards, with a view to 
prevent these cases witnessing distressing scenes occasioned by 
patients labouring under fever. Some of the Orderlies were 
attacked by the disease, but rarely in the aggravated form, as 
very few of them died. In certain localities there was a degree 



Evidence of Dr. Lloyd. 



349 



of panic among the troops, from an impression amons: them that 
the disease was infectious. The officers in Jamaica did not enter- 
tain this idea ; on the contrary, the officers generally of the 50th 
Regiment were very zealous in assisting and visiting the sick 
soldiers in the hospital, suffering under the aggravated foi nis of 
fever ; and neai ly all of them were attacked with either the aggra- 
vated or protracted form of remittent fever; not one of these 
officers, so far as I know, had had the fever before. At the time 
the fever with black vomit prevailed, about four out of ten admis- 
sions died, the other six had the coffee-ground vomit. I have 
never known any of those attacked with the aggravated form, have 
a second attack of the same form of fever. I have often known 
relapses where the coffee-ground vomit took place. 1 have known 
persons who have recovered from an attack of coffee-ground 
vomiting, have (six or twelve months afterwards) an attack of the 
ordinary remittent fever and recover. I have seen the same 
soldiers attacked four or five times in less than three years, with 
protracted remittent, particularly men of the Royal Artillery. I 
consider attacks of the ordinary remittent fever diminish the sus- 
ceptibility to second attacks. 

In September, 1824, when I arrived at Port Royal, Jamaica, 
there was one company of the 77th and two companies of the 
91st regiments. At the time I arrived, there were very few men 
in hospital either of artillery or line. About the end of November 
a severe form of fever appeared, the aggravated remittent fever, 
ending, in some instances, iu black vomit ; the proportion of deaths 
was about 1 to 3 treated. The first cases admitted were from 
the 77th, and I think the first four or five were from two rooms of 
the 77th barracks, which opened into one another; these cases 
were scattered over the rooms; they were all single men; after 
this the cases occurred in different parts of the barracks. At this 
time the married people were not attacked, they were living 
outside the barracks in wooden houses, but when the disease 
extended to the town they suffered, and the troops in barracks 
became comparatively healthy. The nearest married person's 
house was about 90 feet from the barracks, some of them extended 
up into the town; some of the married men were officer's servants at 
the time, others were performing ordinary duties. About one-third 
of the strength was attacked. The officers did not suffer at all at 
this time ; no case of fever occurred in the officers' barracks. One 
officer, however, Lieut.- Colonel Brome, Royal Artillery, died, but 
he lived in the fort, at a short distance from the officers' barracks^ 
and had been at Up Park Camp on a general court-martial, where 
the malignant fever was prevailing. The colonel's servants con- 
tinued healthy. Fever at the town of Port Royal commenced 
about January ; there was no fever at the barracks for six weeks 
previous to this ; the men-of-war were suffering at the time. I 
was a pall-bearer (one of six) at the funeral of a naval officer, and 



350 



Evidence of Dr. Lloyd, 



in three weeks afterwards I was the only one aUve, they having all 
died of fever. At the time the fever prevailed in the barracks it 
also prevailed in the shipping {i. e. the men-of-war) ; I think there 
were four or five men-of-war at anchor, the crews of all the ships 
seemed to suffer. I never met a case of black vomit at Fal- 
mouth, Jamaica; either among the military or civil inhabitants. The 
fevers, at this locality, were of the protracted form ; the majority 
having the cofFee-ground vomit, rarely terminated in intermittent. 

In one instance I placed the substance that subsided in the 
cofFee-ground vomiting in a shovel, and placed it over a fire; it 
gave out a resinous smell and inflamed. At Berbice the ofiScers 
suflfered. When the protracted form prevailed so generally, those 
inhabiting the lower rooms were first afi'ected, those in the upper 
rooms were subsequently attacked. At the time the 50th Regi- 
ment were suflfering from the black-vomit fever, there was a por- 
tion of another regiment at the station, the 91st Regiment. Seven 
officers were present with this detachment, these officers were all 
in the habit of going into the hospital to see their men labouring 
under the black- vomit fever. One of these officers, Captain 
Campbell, and the Assistant-Surgeon, died of the same fever. I do 
not recollect that any of the other five were attacked with any 
disease. The officers of the 50th went more into hospital than 
those of the 91st, from being less apprehensive of the disease, 
having been longer in the island. I never saw black-vomit fever 
in Jamaica, excepting in the sickly season, viz., November, De- 
cember, and January. I have seen an appearance in the mucous 
coat of the stomach resembling sphacelus, but never could per- 
suade myself it was actually gangrenous, it was of a yellowish 
dark colour. At Falmouth the mortality was small. I never 
knew of any case, during my residence in the West Indies, where 
the Yellow Fever was propagated from one person to another. I 
do not believe that fevers arising from paludal or terrestrial sources 
can become contagious under any circumstances. I consider the 
five pall-bearers above alluded to were exposed to the malarious 
cause, prevalent in the environs of the Naval Hospital, Port 
Royal, Jamaica, and thus contracted the disease. 

The sources of such poisons at Port Royal are not altogether 
evident. I never saw a case of intermittent fever at Fort Royal, 
nor at any other station in Jamaica, excepting a few cases at Fal- 
mouth. I have never seen any case of black-vomit fever in Ceylon, 
where I served four and a-half years; in some rare instances, 
there was coffee-ground vomiting; they did not terminate fatally. 
Many of the remittent cases in Ceylon terminated in intermittents. 
About one in three treated, however, among the sailors at Trin- 
comalee, admitted into hospital, terminated fatally. The number 
of admissions was very great out of three men-of-war, the crews 
were not sufficient to work one of the vessels out of harbour. 

]had medical charge of the Naval Dockyard Establishment 



Evidence of Surgeon Brown. 



351 



there, among the black artificers and labourers (principally tmm 
the Malabar coast) as many as 700 were admitted in one month; 
very few died. The symptoms were of a mild character, a small 
proportion terminated in intermittent ; this fever is commoaly 
known by the name of Trincomalee, or jungle fever of Ceylon, 

(Signed) William Lloyd, M.D., 

( Half -Pay ) Surgeon, S6th Regiments 



Evidence of Surgeon Brown^ Grenadier Guards. — January \^ 

1850. 

I have seen Yellow Fever only in Gibraltar, in 1828. It cona- 
raenced about the end of August, and I continued to see cases 
until the end of October, when I was taken ill with the disease; f 
saw no cases after that period. I have never seen ordinary re- 
mittent fever. I served in Gibraltar as assistant-surgeon of the 
43rd, previous to the epidemic between November, 1825, and 
January, 1827; then in Portugal from January, 1827,, till Mai^ch, 
1828, when I returned to Gibraltar with the regiment. Durii^ 
my service in Gibraltar, between November, 1825, and January, 
1827, I never saw any case of what is usually called remittent 
fever. The few cases of fever that occurred in the regiment, I con- 
sidered common continued fevers. The fevers I saw in Portugal 
were few and much of the same description. I cannot assign aiij 
particular cause for these fevers. The epidemic fever I saw ia 
Gibraltar resembled in its early stage the fevers above described, 
About the second day irritability of the stomach set in ; in the 
first instance, the fluid vomited was the contents of the stomach; 
this was followed first by small dark floculi, succeeded by regular 
black vomit. In the fevers I saw in 1826, when vomiting occurr^, 
the fluid ejected was more or less mixed with bile. One patiest, 
in 1825, died under my charge of the description of fever stated te 
have come under my observation in 1825 and 1826, I easanot 
pretend to assign any cause for the occurrence of the epideuak 
fever in 1828. As far as I could see, there was no difFereiice 
whatever in the state of the atmosphere, or the town, as regarded 
filth, drains, &c. 

My regiment was quartered at the Casement Barracks from tk© 
commen cement of the epidemic to about the first week of Sep- 
tember, when the regiment was removed to the Neutral Gro^mi 
and placed under canvass. The distance of the camp from the 
gates of the town was about 500 yards. As far as 1 can re-^olietl, 
only one case in my regiment occurred in barracks, before we wer« 
ordered to encamp. When we were removed, the fever had ii<i& 
reached that part of the town. I continued with the regimeot as 
the Neutral Ground till the middle of October, when I was seiai 
to take medical charge of the 42nd Regiment. During the time 



352 



Evidence of Surgeon Brown. 



that I was on the Neutral Ground with the regiment a consider- 
able number of cases of the epidemic occurred among the men. 
No women, children, servants^ band, tailors, or shoemakers were 
allowed to go into the town, unless on duty. I do not recollect 
any women or children being attacked while I was in the camp, 
either of the 42nd or 43rd. I do not recollect whether any of the 
officers' servants were attacked, nor of the band, or tailors, or 
shoemakers. The cases which occurred were men who were doing 
the ordinary duties in town; this applies to both regiments. Two 
officers of the 43rd and two of the 42nd were attacked. All had 
intercourse with the town. These officers, for some days after 
being attacked, remained in officers' marquees on the Neutral 
Ground, attended by their own servants (soldiers) ; each had one 
servant. None of these servants that I am aware of were attacked 
with the disease. During this time there was a moderate current 
of air right across the isthmus. Each officer was treated in a 
separate marquee. I ordered the walls of the marquees down 
during the hot part of the day, to allow a free circulation of air. 
At all times the circulation of air on the Neutral Ground was 
greater than in the Casement Barracks. This applies generally 
to the whole of the town. The circulation of air at Windmill Hill 
and Europa Flats was equal to that on the Neutral Ground, or 
rather greater. I was in the Naval Hospital, doing duty there, 
between the niiddle of October and the 31st of October, when I 
was attacked with the disease. I did not see any patients vuider 
treatment in the hospital with other diseases attacked with the 
epidemic. When I joined the 42nd Regiment, all the orderlies 
and the hospital-sergeant were suffering from the fever, and the 
hospital-sergeant's wife lyinor dead of it. I applied for feitigue- 
men as orderlies, they were relieved every 24 hours, and I knew 
nothing of the fate of any of them, except one ; he volunteered to 
continue permanently employed, but after three days deserted, was 
tried by a court-martial, sentenced to confinement, was placed in 
the Moorish Castle, where he was seized with the fever and died. 

A corporal who was sent to assist the sergeant (hospital) of the 
42nd, continued to serve during the whole epidemic without suf- 
ieriiig from any disease. He lived in the same room which had 
been occupied by the sergeant and his wife previous to their 
illness. When I was attacked, I was living in the officers' rooms, 
in an upper room, under the same roof as the sick. No other 
officers were living there. My servant, whom I took with me from 
the Neutral Ground, was attacked previous to me, immediately 
after coming to the hospital, and died in the hospital. I took a 
convalescent from the epidemic to attend me when I was ill ; he 
did not suffer from any recurrence of the disease. The Naval Hos- 
pital is badly ventilated, particularly the part occupied by the 
42nd ; they had the back part of the hospital. I could not 
attribute a single case that I saw to contagion. I do not recollect 



Evidence of Surgeon Brown. 



353 



any man of either regiment having a second attack. I think, 
about one-third of the 42nd Regiment had relapses, some of them 
before they were able to get out of bed, others when walking about. 
I have known a relapse occur when the patient had been walking 
about for several days. I could not ascribe these relapses to any 
cause; they were, I think, generally severe cases previous to 
relapse, and some of the relapses proved fatal. The rule in 
Gibraltar was, if any individual could produce a certificate from an 
acknowledged medical man that he had had a previous attack of 
the disease in some former epidemic, he was allowed by the laws 
of the garrison to continue to reside in town, which was not the 
case with others who did not possess such certificates. I think I 
have opened the bodies of about 100 cases. The stomach con- 
tained usually a considerable quantity of black fluid ; it was 
generally found in every stomach, but when the epidemic was at 
its greatest height, it was much more frequent than at the begin- 
ning or decline. The mucous coat was softened, with an irregular 
blush of redness on its surface. In almost every case, the small 
intestines, chiefly the ileum, appeared nearly black, from their 
contents ; the peritoneal coat seemed healthy ; the mucous coat 
as if coated over with black varnish. The mucous coat itself 
softened, tuaiid, and of a slightly red blush. Towards the ter- 
mination of the epidemic, I saw in several cases a greyish substance 
of the consistence of boiled arrow-root adhering to the mucous coat 
of the stomach ai:d small intestines. The colour of the liver 
throughout was much lighter than natural, to wit, buff-orange, 
varying in intensity ; this colour was darker at the commencement 
and termination of the epidemic ; when the disease was most 
severe, the colour scarcely varied. The structure was softer than 
usual ; when cut into, it seemed to bulge, as if it had been released 
from something that had confined it; siz« not altered; spleen 
appeared not altered; convalescence slow. No case terminated in 
remittent or intermittent. During the progress of the disease there 
seemed to be no secretion of bile, at least I saw no evidence of bile 
having been discharged from the gall-bladder. In the Naval 
Hospital the heat was excessively great, between 12 and 4 in the 
day, but not greater than in other years. It was hot under canvass 
on the Neutral Ground, but there was more or less a breeze 
blowing, and the walls of the tents were up during the day to 
allow the breeze passing through. When I performed the post- 
mortem examinations. Dr. Gillkrest was always present. I know 
that Dr. Gillkrest performed post-mortem examinations when I 
was not present, after my removal to the 42nd Regiment ; indeed, 
I know that he inspected all the bodies examined at the Naval 
Hospital, whether of his own regiment or of other corps. Lieu- 
tenant Harris, after his attack, had yellowness of the eyes for some 
time. I do not consider this effect as a consequence of the disease. 
I did not treat Lieutenant Harris. Sometimes portions of the dark 



354 



Evidence of Dr. Jameson. 



matter, stated above as lining the small intestines, were found 
detached and floating in the tube» I have never seen a case of 
intermittent fever in Gibraltar, during the time I was quartered 
there. A number of the convalescents were under the influence of 
mercury (that medicine having been used in the disease). I have 
no reason to believe the hospital-sergeant's room had been cleansed 
and fumigated before the corporal went into it. There were two 
hospital marquees on the Landport Glacis, established in the 
beginning of September. 

(Signed) G. Brown, 

Surgeon, Grenadier- Guards. 



Evidence of Dr. Jameson {Staff Surgeon, Second Class). — 
January 17, 1850. 

I arrived in Jamaica 16th March, 1834, and continued to serve 
there till the 2iid April, 1845, with the exception of about three or 
four months in 1836, when I was on duty at Honduras. In the 
mountains of J amaica I have seen the ordinary synochoid fevers, 
resembling those of England but milder in form. In the other 
parts of the island I saw fevers usually designated intermittent, 
remittent, and the fever commonly called Yellow Fever. I con- 
sider the three latter the same fever, only differing in degree. 
There are no fevers in the lowlands of Jamaica allied to the fevers 
of this country. 

During the whole of 18341 was exclusively employed in hospital 
duties, partly at Up Park Camp, and afterwards at Phoenix Park, 
and was similarly employed for about four years more. The 
other half of my time in Jamaica I was in charge of the head- 
quarter staff, in the paymaster-general's office and medical store, 
and detachment at Kingston barracks. Occasionally during this 
period, for a short time, I had hospital duties at Up Park Camp. 
During my service in Jamaica I saw post-mortem examinations of 
Yellow Fever. In the majority of cases black vomit was found in 
the stomach ; the mucous membrane throughout was more or less 
softened ; in some parts of it red vessels were seen running in 
different directions, and I think I could sometimes express from 
these vessels the same fluid as found in the stomach. The softening 
in some parts amounted to destruction ; in others, when taken into 
the hand, it was easily broken up, and flakes of it were occasionally 
found in the fluid in the stomach. 

The post-mortem examinations were generally performed soon 
after death ; all within thirty hours. The coat I considered disin- 
tegrated, but not gangrenous. Generally speaking, the colour of 
the liver was of the straw-yellow of Syme; in some instances gall- 
stone yellow of the same author. 

In some few cases I have seen it but little altered from its 



Evidence of Dr. Jameson. 



355 



natural colour. The same colours described extended through 
the substance of the liver. As a rule, the liver was generally paler 
than natural ; the substance was friable ; spleen was softened, 
colour darker than natural, amounting in some cases to a pulpy 
mass. In one or two cases the softening of the mucous membrane 
extended down the duodenum, but, generally speaking, the 
mucous coat of intestine was not altered. I have seen a dark 
fluid in the small intestine, analogous to that in the stomach. I 
have seen, in some few cases, a greenish fluid, thicker than tar, in 
the intestines. I have seen repeatedly cases of complicated inter- 
mittent fever terminate fatally. In these cases there was black 
vomit found in the stomach. One case, a sergeant of the 56th 
Regiment, in Phoenix Park, in 1834. I had seen black vomit 
before ; I saw it in this case. This man had been under treatment 
for some days; I think it probable I was giving quinine and 
calomel at this time ; he may have been ordered sherry, madeira, 
or brandy; but not port or porter. There was no instance of 
Yellow Fever at this time in the hospital or neighbourhood. Two 
of his comrades informed me, that previous to his attack he had 
been at St. Thomas-in-the-Vale, about 10 miles from Phoenix 
Park ; also free from black vomit fever at the time. My impres- 
sion is he had been three days ill with intermittent when the 
disease took on the remittent form. 

I define a remission to be a general diminution of all the 
symptoms present, followed by a recurrence of the severe symp- 
toms. These remissions vary very much, sometimes extending 
to 12 hours. From what I have seen, they occur generally very 
early in the morning ; say a little before daybt'eak. I used to 
visit the hospital before daybreak. 

I have never seen simple intermittent terminate fatally, excepting 
in children. In these cases of children there was no black vomit. 

I have seen a few cases of well-marked remittent fever terminate 
fatally without black vomit. In these cases the mucous mem- 
brane of the stomach was softened, and paler than natural. No 
dark fluid found in the stomach, but a whitish-coloured fluid. The 
liver seemed natural, in both colour and structure. These cases 
may have continued eight or nine days before death occurred. 
The spleen was softened; intestines presented nothing unusual. 
Vomiting occurred in these cases ; fluid vomited consisted of 
medicines and fluids taken into the stomach, and other ingesta. 

I consider that if these cases had lived long enough black vomit 
would have occurred. The majority of the cases of black vomit 
fever that proved fatal have had their intellect sufficiently clear to 
answer questions to the last. I have known some persons die 
comatose. 

In the ma,jority of these cases who died comatose, I found 
eff*usion into the base of the brain and ventricles. My observation 
with reference to this last remark refers to what I observed in the 



356 



Evidence of Dr. Jameson. 



56th, 8th, 64th, and 82nd Regiments, when 1 was assisting Dr. Pope 
(82nd), and Dr. Cardiff (8th). I did not record the post-mortem 
examinations made by these gentlemen. I called Dr. Pope's 
attention to these appearances. As regards the brain, I observed 
nothing more unusual. I have known cases attacked a second 
time with the severe form of fever called Yellow Fever. I attended 
Lieutenant Mockles, of the 2nd West India Regiment, in separate 
attacks; the first in December, 1840; the second in autumn, 
1841. In the first attack, this officer had been shooting in 
Caynaans Lagoons, a short time before his attack. Remissions in 
his case were distinct, and he was out of danger, I think, the eighth 
day. He was quartered and treated in Spanish Town. 

At the time an epidemic black vomit was prevailing in that 
locality, and also all over the island. He vomited dark bilious 
matter. The vomiting in cases which ended in black vomit was 
similar at first. On one occasion, I believe. Up Park Camp was 
free from any case with black vomit for three months ; I think 
the September quarter, 1836. I do not 'recollect during this 
period any patient in hospital or orderly attacked with remittent 
fever. When black vomit prevailed as an epidemic fever at dif- 
ferent times, I never remember a single case of a hospital orderly 
or a patient in hospital with any other disease attacked with black 
vomit fever, except, I think, one or two. 

Lieutenant Mockle's second attack took place at Kingston, in 
the autumn of 1841, At Kingston an epidemic black vomit fever 
was prevailing. His attack was similar to his first, only milder. 
I ascribe his second attack to exposure to night air. During the 
malignant epidemic fever, the fatal cases usually terminate on the 
third day, having had distinct remissions during their progress. 

I have never seen black vomit fever occur above 4000 feet. 

I consider that when variola is prevailing epidemically the 
disease is not expected to cease until nearly every individual not 
previously protected shall have been attacked. J conceive it pos- 
sible, but not probable, that a person may be susceptible at one 
time to the influence of a contagious disease, but not be so at 
another time. 

I am inclined to believe that typhus gravior of Cullen, and 
common continued fever of England, are one and the same disease, 
but my experience in typhus fever has been very limited. I con- 
sider them the same on account of their symptoms being equable, 
with the exception of the evening exacerbation. After the exacer- 
bation the fever abates, and continues abated until the following 
evening. I consider that in a marked remittent fever, in the West 
Indies, after a remission there is a marked rigor, followed by a 
hot and sweating stage. 

In the fevers in this country the paroxysm is indicated by an 
increase of heat of skin, of dryness of surface, and increased action 
of pulse. I am inclined to think, according to my views, that all 



Evidence of Dr. Arthur. 



357 



continued fevers of this country are one and the same fever. I do 
not wish to give an opinion with reference to the contagious nature 
of typhus. 

I consider all tropical fevers are periodical, and directly arise 
from the same cause. 

This cause is terrestrial miasma, not atmospherical. 

The difference of the form of remittent fever depends upon the 
concentration of this cause and the varying susceptibility of the 
persons in the locality where it exists. 

One positive fact of a case of contagion must outweigh all nega- 
tive evidence to the contrary. 

Let two ships at sea come within speaking distance. Ship A is 
manned by negroes, unprotected from variola, having had no 
communication with the land or any other ship. Ship A is per- 
iectly seasoned in all respects, perfectly cleanly, and crew in com- 
plete health. 

Ship B has left a port a short time previously, also healthy. 
Ship B sends a boat with a crew and a passenger for ship A, who 
swings himself on board. The passenger having been exposed to 
variola on land before leaving, the disease has remained dormant 
until he arrives in ship A ; he there is attacked with the disease, 
and it spreads through the ship. 

This I would consider a positive proof of contagion ; I would 
consider any identical fact with reference to another disease equally 
an evidence of the operation of contagion. 

I do not consider the case of the "Sybille" and the "Black 
Joke " a parallel ease to the imaginary case of variola. 

I consider that all periodic fevers of Jamaica must necessarily, 
from being periodic, originate from the same cause. 

I conceive that in the ordinary remittent of Jamaica more cases 
occur without bilious vomiting than with it, 

I consider the portions of the mucous membrane stated as above 
as destroyed, to have lost their vitality previous to death. 

There is not a sufficient elevation of land in Barbados, I con- 
sider, to produce intermittent fever. 

I consider the attacks suffered by the 50th Regiment at Spanisii 
Town to have been second attacks of periodic fever. • 

(Signed) J. Ross Jameson, M,D„ 

Staff Surgeon, Second Class. 



Evidence of Dr. J. Arthur, Deputy Inspector- General {Half Pay), 
January 21, 1850, 

I saw malignant Yellow Fever first at Gibraltar, in 1810, on 
board of ship ; afterwards in the West Indies, I consider the 
ordinary remittent of warm climates to be a disease different from 
the malignant Yellow Fever, as the former has a peculiar aptitude 



358 



Evidence of Dr. Arthur. 



to terminate in intermittent, which mahgnant Yellow Fever never 
does ; its peculiarity is its general tendency to terminate in black 
vomit. 

The ordinary or marsh remittent fever occurs in all situations 
where marshes or uncleared grounds exist. I was more than three 
years in the West Indies before I saw a case of this description of 
either marsh or malignant fever. 

The first place I saw it was at Morne Fortune, in St. Lucia, on 
the top of a high hill, surroimded by much uncleared ground, 
and the soil stifif clay, preventing the water penetrating, and so 
retaining it in a favourable position to encourage the decomposition 
of vegetable matter. There it always prevails, and is frequently 
very fatal. I was seven or eight months there (between October 
and June), and it prevailed all the time. The first three years I 
was at St. Pierre, Martinique, the period during which I saw no 
cases of remittents, after a hurricane at Fort Royal, the chronic 
cases of disease at that station were sent to St. Pierre, and amongst 
them most likely there were some cases of intermittent fever. 
This station. Fort Royal, I believe to be marshy, and I have 
understood that remittent fever does prevail there. I have no 
recollection of ever having seen black vomit ejected before death or 
found in the stomach after death in the cases of remittent fever, 
which proved fatal within my own observation. I again saw a 
great deal of the same fever at Guadaloupe, where I had charge of 
the general hospital ; of the medical cases at Basse-Terre, full of 
cases of remittent fever, not only from the troops in the immediate 
neighbourhood, but also amongst those sent from Point-au-Peitre, 
a station most productive of this disease ; sometimes from 60 to 
100 cases were in hospital at the same time. I do not think that 
the deaths amounted to 10 per cent., though many of the cases 
were admitted into hospital in a very advanced state. I recollect 
some cases on that occasion had black vomit ; and one man in 
particular was taken very ill in hospital, and on examination I 
found on the mattress on which he was lying marks of the black 
vomit, which was black vomit from a former patient who had died 
shortly before. I could not account for the aggravation of disease 
of this patient, who was apparently getting well till this time. In 
consequence I reported the condition of the whole of the bedding 
in use, which had been taken from the stores of the French, to the 
Inspector-General of Hospitals, Dr. Ferguson, who ordered a 
Board to report on it ; and the result was that the bedding was 
ordered to be burnt, which was duly carried into effect. 

All the cases of black vomit which occurred at this time were in 
one and the same ward. Precautions were taken on the occurrence 
of this fever, i.e. prohibiting intercourse between them and the 
other patients, and enforcing free ventilation. Shortly after this 
the General Hospital, where this occurred, was broken up, and 
the sick accommodated in the regimental hospitals, which practice 



Evidence of Dr. Arthur. 



359 



was continued till the island was given up to the French. On this 
taking place the English troops were dispersed over the di{Ferent 
islands in the command, and this dispersion was followed by a 
general outbreak of the malignant Yellow Fever. 

I was present at Dominica in 1817 and 18 J 8, when malignant 
Yellow Fever prevailed; also at Tobago, 1818 and 1819; and 
Barbados, in 1820 and 1821. 

In 1820, Yellow Fever was prevalent at Demeraraand Berbice, 
and regulations were instituted at Barbados that no vessels from 
the stations should be permitted to land any person on the island 
until duly authorised, after examination by a medical man. One 
passenger vessel, however, speedily landed her passengers, after a 
lady (an actress) had died during the passage of Yellow Fever. 
The governor was anxious to prosecute the captain, but was in- 
formed by the attorney-general that there was no law enabling 
him to do so, and the local regulation was from this time 
neglected. Yellow Fever began (o prevail at Barbados within a 
short time after this, and continued during the latter end of 1820 
and beginning of 1821. During the period of its continuance no 
cases of the ordinary marsh remittent fever were observed, nor any 
of intermittent; indeed, I never within my own experience knew a 
case of the latter disease originate in Barbados. On one occasion, 
when some severe cases of fever were landed at Barbados from 
H. M. ships from St. Lucia, I remarked to some of the gen- 
tlemen present, You will see, if any of these recover, they will 
terminate in intermittent fever." This happened as 1 predicted. 
The places where I consider remittent fever to particidarly prevail 
are Morne Fortune, St. Lucia, Somlau Petre, Guadaloupe, 
and Prince Rupert's, Tobago, in consequence of the Baccolille 
swamp. The other islands and stations I cannot speak of from 
personal experience. I recollect Staff Surgeon Panting, when the 
disease. Yellow Fever, broke out at Tobago, and who was, in 
addition to his medical duty, in extensive private practice, stating 
that the disease was so new to him that he thought it his duty to 
apply to Barbados for assistance. He had himself suffered from 
Yellow Fever long before at Martinique, soon after his arrival in 
the West Indies; I think about 1795 or 1796; and that since 
that period he had seen so little of the disease, and never at 
Tobago (where he had been many years engaged, as above 
stated), that he was greatly alarmed at its occurrence. At the 
time that the mahgnant Yellow Fever prevailed at Tobago there 
were some cases of intermittent fever in the hospital in troops who 
had been sent from Trinidad, but there was no prevalence of cases 
of the ordinary marsh remittent at the time; the disease Yellow 
Fever was as prevalent in the town as in the garrison. I do not 
recollect to have heard what fever was prevalent in the countr3^ 
Dr. Panting did not sicken of this fever. 

I did not suffer from Yellow Fever in the West Indies ; I suf- 



360 



Evidence of Dr. Arthur. 



fered from it on board ship, in Gibraltar Bay, in 1810. I have 
known many instances of persons, after having had one attack of 
Yellow Fever, who were afterwards exposed to it and continued 
healthy; indeed, I know of no person having had two attacks of 
the malignant Yellow Fever. I did not see anything that I could 
call a remission in the fever at Barbados; that is, no distinct 
abatement of symptoms, followed, sooner or later, by an aggrava- 
tion of symptoms, such as takes place in the ordinary marsh 
remittent fever. 

The disease which prevailed on board the ship in which I was 
stationed in Gibraltar Bay, in 1810, presented the characteristics 
of the malignant Yellow Fever, i. e. febrile symptoms, often followed 
by oozing of blood from corners of mouth, corners of eyes, livid 
yellowish colour of the skin, and black vomit; the mortality being 
three in five. Before I went on board, the transports were clean 
good vessels, and the sick were distributed in these vessels, though 
they might have been put into one without being crowded. The 
men of these vessels were clean, good, healthy men, and had been 
taken good care of ; deserters from the French army. These men 
were in good health previously to touching at Carthagena, while 
malignant fever prevailed there, I think they caught the disease. 

The fever broke out in these vessels during their passage from 
Carthagena to Gibraltar. 

At Tobago Dr. Cummings' wife, a native of the place, took fever 
when it prevailed there, and died, and some of the oldest of the 
population suffered. Several fresh troops arrived in the West 
Indies between 1816 and 1821. Most of the regiments at Guada- 
loupe when they suffered had been long in the country ; does not 
think there was one newly-arrived regiment there. 

In 1821, when the 21st Regiment was attacked at Barbados, 
every precaution was taken to prevent intercourse between the sick 
and well. Before the garrison sufiered from the disease every 
means was taken to prevent intercourse between the gariison and 
inhabitants of the town and neighbourhood, who were suffering 
from the disease. The Royal Artillery were the first attacked in 
garrison ; they were encamped close to the barracks, and inter- 
course with the rest of the troops prevented; and the marked 
cases were sent to the naval hospital appropriated for the reception 
of cases of malignant fever. The disease soon ceased with them, 
but appeared in one company of the 21st Regiment, proceeding 
from man to man. This company was immediately encamped, 
and treated as the Artillery were ; the disease in them also soon 
ceased. A second and third company suffered in a similar 
manner, and were alike treated, with similar results. During this 
period the remaining companies continued in the barracks in the 
enjoyment of perfect health, 

1 think every means was taken to prevent communication 
between the men in tents and those in barracks, I think about 



Evidence of Dr. Millingen. 



361 



\hree men were placed in one tent. This the barrack in which 
the 21st were quartered, was the same in which the 2nd Foot 
suffered so much in 1816, when similar precautions were not 
taken. I think the rooms in which the men suffered were the 
lower rooms. 

(Signed) John Arthur, M.D., 

Deputy Inspector- General of Hospitals 
{Half Pay), 



Evidence of Surgeon Dr. Millingen, ^Ist Regiment. — January 22. 

Saw Yellow Fever in the West Indies, i. e., Dominica and 
Barbados, in 1841-1842, when it prevailed on both occasions epi- 
demically. Was 22 months in the command. The diseasa com- 
menced in August at Dominica in the 92nd Highlanders, of which 
I was assistant surgeon. Strength of detachment, 189 men and 7 
officers. The health of the troops previous to this was good, 
excepting slight remittent fevers, which in no instance proved fatal. 
A ship arrived from jSartinique about the first week in August, 
named the Funchall." She had come to Dominica in ballast, 
after having landed a cargo of fish which she had brought from 
Newfoundland, which she landed at M?a'tiniqiie. She had a 
crew of 13 men, of whom, on her arrival, 1 think three or four 
were suffering from Yellow Fever. I understood the Yellow 
Fever was prevalent at Martinique when the " Funchall " left that 
island. The sick of fever of this vessel were landed in the town of 
Kossena. I think, of seven cases landed, three or four proved 
fatal; almost immediately after this the disease broke out in the 
town. The ship was not put in quarantine, and I am not aware 
that any precautions were taken to prevent such of the crew as 
were not sick communicating with the population. Hie disease 
was pretty general in the town amongst Europeans. The disease 
was latal in a great many cases. The troops were not prevented 
entering the town during this period of sickness. There was a 
military guard at the time on Government House, situated in the 
centre of the town. 

The fort adjutant, the Commissariat officer, and the Treasury 
clei'ks, as well as the Governor and his staff, resided in the town. 
The Governor had a wife and one child ; the Commissariat oBicer 
also had a family. The Governor had a batman, a soldier of the 
92nd^ and one European maid, and his other servants were 
natives, as well as those of the other officers. There was also 
Captain Griffiths and his wife, of the 1st West India Regiment, 
residing in the town. Lieutenant Riley, the fort adjuiant, was 
the first military officer attacked; he died, not having had 
black vomit, so far as I know and recollect ; the body was not 
opened. This officer, with three or four other persons, had been 

2 B 



362 



Evidence of Dr. Millingen. 



on a pic-nic party to a river, some miles off, and had been a good 
deal exposed, in fishing, &c., tor more than one day. Three at 
least of this party were attacked with fever on their return ; Lieu- 
tenant Riley, about two days after ; the others a few days after 
him. Of the three, two died and one recovered. I designate a 
remittent fever one which has,, in the course of the da}^ an abate- 
ment of the symptoms, followed by an exacerbation. Lieutenant 
Riley's fever, with reference to the above definition, was not a 
well-marked remittent, though I think there was a slight abate- 
ment of symptoms, followed by an exacerbation. I think, every 
morninor whilst the disease lasted, there seemed to be a slight 
abatement of symptoms. I do not remember his having had any 
severe vomiting. Dr. Imraj^ a civil practitioner, attended the 
other two cases ; therefore I cannot speak of them. After Lieu- 
tenant Riley's death, I suffered from a slight fever of three or four 
days' duration, which I ascribed to fatigue from attending on 
Lieutenant Riley. 

About the 16th of August, Major Hort's batman was taken ill 
of fever, and sent to the military hospital, where he died, I was 
told, of Yellow Fever. I do not remember any of the sick (about 
15 or 16) at that time in hospital being attacked. The hospital 
was situated on an elevation of 300 or 400 feet, and exposed to a 
strong draught of wind, which always blew along the Rossena valley. 

Mrs. Hort died about two days after the batman. She died of 
Yellow Fever, but I do not remember if she had black vomit. I 
never heard of the European servant maid of this family having 
suffered. A few days after the batman died, some of the men 
were taken sick. The cases came into hospital from day to day, 
with sometimes a day or two elapsing without any case. Black 
vomit then became a common symptom. Lieutenant Gordon was 
then attacked and died, and he had profuse black vomit and con- 
vulsions : the latter (convulsion) was a common symptom in the 
fatal cases. In a good many cases there was haemorrhage from 
the gums and anus. I think there were 205 cases treated, of 
which about 48 died. The disease continued until the detach- 
ment was removed from the island in November; the cases 
diminished in frequency about the beginning of November. 

In one barrack-room the disease seemed to spread on one side 
of the room, while the other side remained free ; it broke out on 
the windward side, and eventually extended to the other. I do 
not remember that feature in the other room. The men only 
occupied two rooms, which were in buildings distinct from each 
other. All the barracks are ground-floor apartments. When the 
disease broke out, I had the women and cFiildren removed into a 
separate apartment, distinct from the men. Those of the women 
who had not already had the disease were nearly all attacked 
after the removal. Those who had been first attacked in the 
barrack had been moved into this room, in which the remainder 



Evidence of Dr. Millwgen. 



363 



were afterwards placed, and treated there. The children suffered 
in a less proportion than the grown iippeopl*^. I do not remember 
a child having had black vomit, thou ah Dr. Birrel informed me 
that a child who had, recovered. At that time I did not consider 
that the disease was contagious, though now, after reflection, I 
should not consider myself doing my duty if I did not take precau- 
tions which at that time I did not believe necessary. 

The stomach after death usually contained a dark-brownish 
fluid, which was sometimes black, vai-ying in quantity from four 
ounces to two pints. The mucous membrane generally was 
softened and pulpy. The vascularity was increased throughout, 
but never distinct in certain patches. The mucous membrane 
was easily detached by the handle of a scalpel. On the surface of 
some of these patches, small dark flocculi were observed, similar 
to those in the black-vomit fluid, and these could easily be washed 
off. 1 did not see any evidence of abrasion^ but it appeared as if 
the blood had oozed from the surface. The mucous membrane 
was of a pinkish hue, varying in intensity. 

The liver did not appear to differ in size, though in structure it 
was more friable. The convex surface of the liver was of a colour 
intermediate between gall-stone yellow and gamboge yellow of 
Syme. This colour pervaded the structure of the organ, as well as 
the under surface. There was a great deficiency of blood in the 
organ. The gall-bladder was sometimes empty, seldom distended, 
but generally about one-thircj full of dark tarry-looking bile, 
which bore no resemblance to the fluid in the stomach. I have 
seen the same floccvdi (noticed in the stomach) also in the small 
intestines, i. e., in the upper portion, and in these adhering to the 
inner coat. 

I am of opinion that this fever was decidedly different from the 
remittent. The fever throughout its whole course seemed different, 
and in the Yellow Fever there is a peculiar smell emitted from 
the body. The ordinary remittent of the West Indies has distinct 
remission ; the vomiting generally bilious. These fevers, in my 
experience, seldom terminated in intermittent. 

Ensign Davis had remittent fever at Dominica, of which he 
had frequent relapses. The detachment from Dominica was 
moved to Barbados, and all the men who had escaped the disease, 
as well as those who had recovered, were present in the garrison 
of St. Anne's, Burbados, during the prevalence of epidemic 
Yellow Fever in 1842. When we arrived from Dominica, the 
47th Regiment were suffering from fever at Barbados, and we 
lost one man; the 92nd were under canvass at the Racket Court. 
At Dominica, I think I recollect some cases of second attacks, 
where the fever was of the same desci iption as the patient had 
previously laboured under ; others appeared to have been from 
acts of indiscretion, and the fever seemed different, but cannot 
speak decidedly on this point. 



364 



Evidence of Dr. Millingen, 



I was stationed at Ceylon for 20 months; saw no fever there 
resembling the fever at Dominica as above noticed. The remit- 
tent, or jungle fever of Ceylon, partook more of the character of 
remittent than of Yellow Fever. I saw several officers at 
Columbo, who came from the interior, suffering from jungle 
fever. They were very liable to relapses, and frequently required 
to be sent to England before they could get quit of the disease. 
Have seen fatal cases of continued fever at Cobimbo, but never 
saw black vomit. The Cingalese suffer very much from remittent 
or jimgie fever. I was in medical charge of the civil hospital, 
where many died, and never saw anything bordering on black 
vomit. 

In Dundee I saw a fever of a typhoid character in the civil 
infirmary, I think, towards the end of 1843, or beginning of 1844. 
In the stomach of the fatal cases was found a brow^n fluid, bearing 
a resemblance to the black vomit. In this respect, the fever had 
a resemblance to Yellow Fever, but in its progress it was different. 
There was another kind of fever prevailing in Dundee at the same 
time, in which there was at the commencement of the febrile 
symptom a coloured eruption, about the size of millet-seeds, dis- 
appearing on pressure. I did not remark any eruption in the 
cases where the dark fluid was found in the stomach. 

In the fever which occurred at Domin'ca, the convalescence was 
slow, but more slow when bleeding was employed. I think I 
must have opened about 40 bodies in the West Indies, and although 
in some black vomit had not been ejected during life, it was 
invariably found in the stomach. 

My experience leads me to believe that the smell emitted from 
the bodies of Yellow Fever patients is different to that which I 
perceived in cases of remittent fever in the West Indies or Ceylon, 
or in any other disease, indeed. 

Examination continued. — January 23. 
In addition to the persons mentioned as residing in the town of 
Rossena at the time of the outbreak of fever there, there was also 
Lieutenant Monro and his wife. This officer was preparing to 
embark for Europe at the time the fever commenced, but before 
going on board tFie vessel he suffered from a slight indisposition, 
which I attributed to exposure to the sun and exertion in making 
preparation. He was confined to bed for 24 hours, and in 48 
hours he was enabled to continue his preparations, which lasted 
for four or five days. He embarked in the " Ealing Grove,'' and 
on the day he embarked I w^ent on board this vessel, where I found 
a sailor, in my opinion, labouring under Yellow Fever, lying on 
the deck- Notwithstanding this, the vessel put to sea in a few 
days. Besides Lieutenanl Monro and iiis wife, there were pas- 
sengers. Lieutenant Lacey and a boy named Blanc, about nine 
years old, going home for education. Letters were subsequently 



Evidence of Dr. Wehb. 



365 



received, stating that Lieutenant Monro died six days after em- 
barkation of Yellow Fever, also the young boy, about the same 
time, and that Lieutenant Lacey had suffered from the fever in a 
severe form. Captain Faulkner, the master of the vessel, was an 
old West India trader, who, I think, was likely to know Yellow 
Fever. I heard that the sailor above referred to died. A setter 
dog, belonging to Lieutenant Hales of the 92nd, who came from 
St. Lucia to Dominica, became ill. I saw the dog: the con- 
junctivae, gums, and inside of the mouth were strongly coloured 
yellow, and when the dog died, I found in the stomach some fluid 
(two or three ounces), exactly resembling the black vomit. This 
officer arrived during the time Yellow Fever was prevailing at 
Dominica. 

(Signed) H. Milling en, 

Surgeon, 315^ Regiment. 



Evidence of Staff Assistant- Surgeon Dr. Webb. — January 23, 

1850. 

I served in the West Indies from November 1845 to July 1849 ; 
during that time I was stationed at St. Lucia and Barbados. I 
saw Yellow Fever at St. Lucia and Barbados. At the former 
island 1 saw three or four cases of fever, which I now consider 
to have been Yellow Fever, for the skin was yellow, great 
gastric irritability, and the peculiar appearance of countenance 
characteristic of Yellow Fever. The fluid vomited was first of a 
greenish tinge, and afterwards became of a chocolate colour. The 
vomiting lasted for two days, more or less. None of these cases 
died. The disease lasted five or six days, i. e., till I considered 
them out of danger. I returned some of these cases as febris 
remit tens. 

I define remittent fever to be, a fever in which abatements of 
symptoms, followed by exacerbations, occur. Such phenomena 
took place in the fevers above referred to. With the exception of 
these cases, the troops were not at that time (I think, June and 
July) suffering from any other fever, nor did they during the time 
I continued on the island, which was till Febi'uary following, with 
the exception of some slight cases arising from drink. 

In the middle of December 1847, 1 saw Yellow Fever at Bar- 
bados, and continued to see cases until the early part of 1849, 
when the disease ceased there. I observed no remi^ssions in the 
cases of Yellow Fever which I saw in Barbados. 

I sav,' cases of Y^ellow Fever during the prevalence of the 
disease at Barbados, which were not so severe as those I saw at 
St. Lucia ; and in these cases the fever was continued. Notwith- 
standing, I consider that these cases, and the cases I saw at St. 
Lucia, were one and the same disease. I think I was present at 



366 



Emdence of Dr. Webb. 



more than 100 post-mortem examinations of subjects who died of 
Yellow Fever at Barbados. The stomach was distended with 
gas, and contained more or less black vomit. I do not recollect 
having been present at the opening of any body when black vomit 
was not found. The mucous membrane was, generally speaking, 
softened, and reddened in patches, chiefly at the cardiac extremity. 
The patches were fiom ecchymosis, and were of a colour inter- 
mediate between purplish red and lake red of Syme. Patches 
varied from a fourpenny piece to size of a half-crown. The sur- 
face of the patches was smooth, and sometimes flocculi, hke those 
found in the stomach, were observed. The liver was soft and 
friable, and the vessels were congested w ith blood. The surface- 
colour nearly the wine-yellow of syme, waxy yellow. I only saw 
one exception to this — Dr. Irvin, assistant-surgeon, 7"2nd Regi- 
mtnt. His liver was smaller than livers usually are, and exces- 
sively congested, and of a dark colour. The colour of the sub- 
stance of the liver was in all instances the same as that described 
to be that of the surface. Gall-bladder was sometimes full, and 
sometimes all but empty; generally of a dark colour, and inspis- 
sated. I observed black vomit generally, both in the large and 
small intestines; it was floating in the tube. Towards the stomach, 
the mucous membrane was of a dark colour. Did not observe 
any organic disease in the intestines. The spleen was a little 
softer than natural, but nothing remarkable in point of size. I 
have never, within my experience, known a person to have had a 
second attack of Yellow Fever. I saw no case of relapse. I con- 
sider Yellow Fever, and the ordinary remittent fever of the West 
Indies, to be specifically different. In remittent fever, rigors 
usually usher in the disease. In Yellow Fever, rigors do not 
generally occur ; the patient only experiencing a shght chilliness. 
The appearance of the countenance is different in the two diseases, 
but the exact difference not to be conveyed by language ; but I 
think I could always discover the one disease from the other by 
this peculiarity : w hen the disease, i. e., Yellow Fever, is esta- 
blished, there is a greater degree of general excitement and alarm, 
and more intensity of symptoms, than in the remittent fever. In 
Yellow Fever, the eyes present the appearance of those of 
drunkards, which they do not in the remittent. I saw some cases 
of remittent fever amongst the black ti oops at Barbados. I con- 
sider the Yellow Fever at Barbados to have been produced by 
some specific poison, assisted by some atmospherical causes. I 
think the poison to be an emanation from the ground, and absorbed 
into the blood through the lungs. I do not think the disease is 
capable of propagating itself by contagion. Some cases occurred 
at Barbados which had the appearance of having arisen from con- 
tagion ; viz., the Ross family, residing in a house in the New River 
road, on the margin of the river, about a mile and a-half from the 
barrack, opposite to which, when the tide is low, there is a quan- 



Evidence of Staff Surf/eon Blaheneij. 



367 



tity of slime and mud, and stunted vegetables. Kound the house 
there was no accumulation of filth (so far as I know) within the 
circle of 100 yards. There are other houses occupied by res- 
pectable persons : none of these parsons suffered at the time the 
Ross's did. The daughter of Mr. Ross was first seized, about 
November 1848; the mother next; then the father, and then the 
son, who, i.e., the son, had been residing in the house from the 
time that the family were attacked. The mother was an aged 
woman. One other extraordinary circumstance is the case of the 
hospital bath-man and hospital servants, and sick of other diseases, 
being attacked ; but I th-nk I can account for their suffering from 
the operation of local causes. The bath-man*s wife was attacked, 
and then the husband, who attended her. On the other hand, 
when Lieutenant Norrie, R.A., suffered from the disease in 
March, there were several officers lately from England living in 
the same house, and they attended him ; the room was well venti- 
lated. None of these oflScers suffered an attack for three weeks 
afterwards, when Lieutenant Romes was attacked. Two or three 
artillerymen were in attendance on Lieutenant Norrie. This 
officer vomited blood before the black vomit appeared. 

I have known a case of typhus fever occur in a clergyman's 
family in England, without the disease extending to any other 
member ot the family, eight in number. Promises to furnish a 
written record of some more cases where the disease did not 
spread. Convalescence slow, the digestive organs being* weak- 
ened. 1 consider that the commonest diseases often pass through 
a family in succession, without any suspicion of contagion. 

Dr. Webb was, during this period, in charge of the apothecary's 
store, and only occasionally called upon to assist in the medical 
duties of the garrison, except on one occasion, when, for about 
10 days or a fortnight, he had medical charge of the Royal Artil- 
lery during the illness of Senior Surgeon Whitelow; the artillery- 
men had not at this time begun to suffer. He was frequently in 
the regimental hospital of the garrison. 

(Signed) H. March Webb, M.B., 

Staff Assistant- Surgeon. 



Evidence of Staff Surgeon {Second Class) Biaheney. — 
January 28, 1850. 

Served in the West Indies from February, 1838, until May, 
1840. Saw Yellow Fever at Demerara and Barbados. 

I consider Yellow Fever a different disease from the ordinary 
remittent fever of the West Indies. I mean by remittent fever, 
one marked by periodical remission of symptoms tbllowed by 
exacerbations. At Demerara 1 saw, I think, about 50 cases of 
Yellow Fever in 1839; the fever was of a continued form, and 



368 Evidence of Staff Surgeon Blahenei/. 



black vomit was a common symptom. I performed all the post 
mortem examinations. The mucous membrane of the stomach 
was generally thickened and softened with numerous echymosed 
patches and points of extravasation. In some cases there was 
general increase of vascularity, saw no detached portions of the 
inner coat. The stomach invariably contained the black vomit in 
more or less quantity. The liver usually enlarged and much 
gorged with blood. Structure triable and easily broken down. 
The colour on the convex surface was generally straw-yellow, in 
some cases ash-grey. I do not recollect the colour of the sub- 
stance of the liver; gall-bladder sometimes distended with viscid 
bile, and in other cases it contained but little. I do not recollect 
the appearance of the contents of the intestines ; spleen was usually 
enlarged, structure disorganised, much softened, and readily 
broken down ; 1 can assign no cause for the disease. I recollect 
a quantity of bush to windward of the hospital was cut down, and a 
quantity of vegetable matter exposed ; this occurred in other years 
when no Yellow Fever appeared. 

The patients with Yellow Fever were not isolated from the other 
patients. I do not recollect any case of Yellow Fever originating 
in the hospital. The disease was general in the regiment, and not 
confined to any particular locality. We never thought about 
contagion, we were very much occupied, nor did either men or 
officers think of contagion so far as I know. 

I do not recollect any person having suffered a second attack of 
Yellow Fever. I do not recollect any cases of relapse, no officers 
on this occasion suffiired from the disease. I do not recollect any 
case of Yellow Fever terminating in either remittent or intermit- 
tent fever ; a number of intermittent fever cases were treated, 
some of which merged into the remittent form. I do not recollect 
any cases of remittent fever having passed into Yellow Fever ; the 
first cases occurred amongst the militar3^ The 67th Regiment 
had been stationed in the different islands in the command since 
March, 1833; hence had been between five and six years before 
the outbreak of the disease. There was a number of vessels in 
the river at the time. 

I do not recollect that any case of Yellow Fever existed in the 
town when the military were attacked. Before it ceased among 
the military the crews of the ships began to suffer, and afterwards 
it extended to the civil population I believe it was very fatal to 
the shipping, and also in the town. 

I was informed by an old resident that previous to this invasion of 
Yellow Fever there had been no invasion of the disease for 15 years. 

Saw Yellow Fever in 1840 in Barbados, the sick having been 
disembarked from one of Her Majesty's vessels, " Vestal," who 
were treated in the 67th hospital, of which I had charge. This 
vessel was stated to have a quantity of unbarked wood on board, 
for what purpose does not know. 



Evidence of Sir William Pym. 



369 



The sailors stated that a few days after the}'' sailed from 
Trinidad the stench was horrible from this, and that many of them 
sickened. I think there were about 40 men sent sick. 

Hsemorrliao^e from nose and o^ums not common at Demerara. 

The 76th Regiment, which relieved the 67th at Demerara, 
suffered very severel}^ from Yellow Fever. 

From my present impressions I should not separate Yellow 
Fever cases from the rest of the patients. 

(Signed) G. H. Blakeney, 

Staff Surgeon, Second Class. 



Evidence of Sir William Pym, Inspector- General {Half -pay). 
Superintendent- General of Quarantine. — January 29, 1850. 

I consider Yellow Fever and the ordinary bilious remittent 
fever of hot climates to be specifically different diseases. Remit- 
tent fever exists in many parts of the world; in Syria, in the 
Levant, in India, on the coast of Africa, and in different parts of 
the West Indies, and its cause is well known, viz., exhalations 
from marshy or uncultivated grounds, and in those only. In 
many of these places it is a disease of season ; in others, as the 
coast of Africa and perhaps certain localities in India, it is con- 
stantly prevalent. These remittent fevers exist in different degrees 
of severity, such as at Walcheren, Minorca, the coast of Africa, 
and the East Indies. The disease at the two first stations I con- 
sider to be a much milder form than the highly concentrated 
form of the jungle fever of India and the remittent, as it occa- 
sionally occurs on the coast of Africa. I consider that the name 
bilious remittent fever* clearly indicates the nature of the disease, 
being attended with regular remissions, followed by exacerbations 
with increased action of the liver. I consider this fever to be 
essentially different, from persons who have had one attack of 
remittent fever being rendered highly susceptible to a second 
attack when exposed to malarious influence; persons also Avho 
have had an attack of remittent fever are very liable to be 
attacked with intermittent fever, followed by visceral disease, par- 
ticularly of the liver and spleen 

I have seen a great deal of the remittent fever, particularly at 
Port Royal, Martinique, and in Sicily, and three cases in Gibraltar,* 
who were in gentlemen who had been exposed in a damp situation 
in Spain. . On their return they were attacked in succession with 
a severe form of remittent fever, characterized by regular remis- 
sions, followed by exacerbations and sickness at stomach, with 
bilious vomitings. I have not seen a case of intermittent fever 
which proved fatal examined after death, but I have seen cases 
during life where the liver was manifestly enlarged. At the period 
1 speak of post mortem examinations were not generally made. 



* See Return, pp. 94, 95. 



370 



Evidence of Sir William Fym. 



The Bulam fever differs first in being more rapid in its progress 
has no remission followed by exacerbation, although there may be 
occasionally an apparent alleviation of symptoms. The Bulam 
fever, unlike the remittent fever, which exists only in unhealthy 
situations, prevails in all situations as well as at all seasons of the 
year. One attack makes the human frame proof against a second, 
in the same degree as small-pox. 

Patients having suffered from this disease are not liable after- 
wards to suffer from intermittent fever as the termination of the 
disease, nor do they suffer from visceral diseases as the conse- 
quence of the attack of Bulam fever. Patients are very frequently 
attacked with a very mild form of Bulam fever, this mild form 
gives the constitution the same security from a second attack as a 
severe one. 

This mild form is by many people put down as a case of the 
highly aggravated form of tlie remittent. A marked difference also 
in the two diseases is the increased action of the liver in the former 
(remittent), and the apparent total want of secretion of bile in the 
other (Bulam), throughout the disease ; that is, that in the Bulam 
fever in a severe form the liver soon loses the power of secretion, 
as well as do the kidneys. 

The convalescence of those who recover is rapid. To constitute 
the genuine remissions of which I have spoken, I consider it 
necessary that there should be a great diminution of the febrile 
symptoms, the exacerbation following ushered in by chills, some- 
times rigors, with a return of the sickness or vomiting. 

While I was in the West Indies the Bulam fever prevailed at 
all seasons of the year. 

After the taking of Guadaloupe [ was sent off to Martinique to 
join the 70th Regiment, in consequence of the surgeon and 111 
men having died in the month of April, 1794, in that island, from 
which time it continued to exist at all periods for two years without 
intermission. All new arrivals from England being soon attacked. 

T 1 -r-» 1 ~ ^ . 

In the Bulam fever black vomit was very general, almost in 
every case, and in the few cases which were examined it was found 
in the stomach. The patient in the Bulam has sometimes been 
supposed to be convalescent from the total cessation of all com- 
plaint, fancying himself quite well, but on making even a slight 
exertion nearly fainted, after which black vomiting came on im- 
mediately, which continued from 1 to 14 hours, when the patient 
died. 

I was at the capture of Martinique in 1794, and wheii I left it 
with the expedition for St. Lucia and Guadaloupe, the troops and 
population at Martinique were perfectly healthy. After being at 
Guadaloupe two or three days an express came to the Com- 
mander-in-Chief, reporting the outbreak of fever in the 70th Regi- 
ment at Port Royal, Martinique. The disease showed itself first 
in a casemate-barrack in Fort Edward, its orif^in could not be 



Evidence of Dr. Gillkrest. 



371 



accounted for ; about the sixth or seventh day after I joined the 
regiment, as I have ah'eady stated, I found several of the officers 
and men ill ; I was attacked myself the sixth or seventh day after 
my arrival, having previously recommended the removal of the 
regiment to Point Negri. 

With reference to the allusion to Carpitole in Sh' W. Pym's 
work, page 8, the author is not prepared at present to state how long 
the regiment remained at Point Negri before they were removed. 

With reference to Gibraltar, I believe that Louis mentions that 
from its being believed that children suffered less than adults from 
Fellow Fever, parents were in the habit of exposing their children 
for the purpose of contracting the disease, so that they may escape 
it when they became adult, and liable to suffer more. 

I have seen a great number of vessels arrive in the West Indies 
while I was there in the years 1 794 and 1795, which lost so many 
of their crew from Yellow Fever that hands did not remain to man 
the vessels. 

I consider a contagious virus cannot originate de novo, that 
when any contagious disease breaks out in any locality there 
mast have been there a virus previously generated, but previously 
inactive. 

I have heard that Bulam fever broke out in Chichlana, or 
Medina Sidonia, in Spain, at a time when it was not known to 
exist in any other part of the country, and its outbreak could not 
be accounted for. When the disease prevailed at Cadiz on 
another occasion, I heard that a cordon sanitaire was established 
which prevented the introduction of the disease into this village. 

I do not consider that a great number of cases of disease occur- 
ring at the same time is a proof of contagion. I believe that the 
ordinary remittent can never under any circumstances become 
contagious. 

In 1810 the measure I recommended was to place a sentry on 
every infected house, till the sick were removed to the neutral 
ground, and a cordon of troops round the infected locality ; and 
I believe every person infected with the disease was included, ex- 
cept, I think, Captain Boyd who was at a distance up a hill (also 
drier), and a priest who was removed to the neutral ground. I 
knew three officers. General Binkeley, Colonel Garconne, and 
Colonel Otway, of the Artillery, who having had Yellow Fever 
previously, escaped an attack when lately exposed at Barbados. 

(Signed) W. Pym. 



Evidence of Dr. Gillkrest, Inspector- General (Half -Pay). — 
February 5, 1850. 

Exemption from second attacks of Yellow Fever in Gibraltar, 
in 1828, was very great ; this exemption is a popular tradition 
long established throughout Spain. 



372 



Evidence of Di\ Gillhrest. 



Submitted a list of 23 cases of second attacks, a copy of which 
he promises to furnish to the Board. I think it likely that some 
of the cases were produced to the Board assembled in Gibraltar 
in 1829, to inquire into the liability or non-liability to second 
attacks of Yellow Fever. 

The belief of persons not being susceptible to second attacks was 
acted upon in Gibraltar in 1828, with regard to the selection of 
persons being exposed to the disease. Civilians on this account 
were employed as hospital attendants in military hospitals, I do 
not recollect how many soldiers, who were employed as orderlies 
in hospital, were attacked with the disease. Mentions 69 fatigue 
men of 43rd Regiment who were employed as orderlies in attend- 
ance on the sick.* List to be given to-morrow, showing the 
proportion attacked. I do not know that any of the civilians 
who acted as sick orderlies were attacked. 

Some old families in Gibraltar held the opinion that children 
being born in Gibraltar enjoyed as great an immunity from the 
disease as those who had undergone an attack. The same belief 
is held in Spain by many with regard to persons born or long 
resident in the West Indies; that is, that they were equally pro- 
tected as if they had had an attack of the disease. Berthe and 
others mention this. 

I believe it was the opinion of some that children had the disease 
generally in a very mild form, and in consequence it was w ished 
that their children should contract the disease at an early age. 

I consider that typhus fever is a disease that gives immunity 
from second attacks of that disease, but from my long experience 
I do not consider that disease contagious; and I found this upon 
the fact of my having, in the course of my services as regimental 
surgeon, seen the disease in hospital almost every year, and in no 
case whatever have I witnessed its transmission from the person of 
a soldier labouring under the disease to that of others. Not even 
after the Corunna retreat, when our hospital in the 43rd Regiment 
may be said to have been crowded with typhus in its very worst 
form (in the hospitals at Colchester), on which occasion the inte- 
guments of the lower extremeties absolutely sloughed away, as was 
witnessed by Sir J. Webb, then senior medical officer there. The 
disease altogether remained confined to the individuals who had 
passed through the severity of that severe campaign. 

After close attention, I beUeve the epidemic Yellow Fever of 
Gibraltar in 1828 was of the same family as the severe remittent 
fever of tropical climates ; both arising from malaria in its ex- 
tended sense, and not confined to the miasms from marshes, but 
may be produced by a deficient element in the atmosphere, or an 
element superadded. We know that in its production epidemic- 



* This list will show that the proportion attacked was something less than men 
of the regiment not employed as orderlies. 



Evidence of Dr, GilJhrest. 



373 



ally, heat though not. to an extreme degree is essential, say- 
between 60 and 75 or 80 ; sporadic cases may occur at a lower 
range. 

Locality influences its appearance very much, as lately exem- 
plified in Barbados and many other places. 

The great majority of epidemics throughout Spain as well as 
Gibraltar have been in the last third of the year, that is, from about 
the middle of August to the last day of the year, as admitted by 
the great authority Arejula, and many others. 

The arrival of fresh troops in the West Indies always furnishes 
fresh materials for the prevalence of Yellow Fever epidemics. 

I consider that an attack of intermittent and remittent fevers of 
tropical climates does not afford an immunity from a second 
attack, nor do I think that one attack of Yellow Fever furnishes 
an absolute security from another. 

I cannot speak positively as to whether one attack of remittent 
fever increases the susceptibility to a second attack. 

I had some men in the 43rd Regiment who suffei ed repeatedly 
from remittent fever and agues. 1 cannot speak with reference to 
relapses in remittent and intermittent fever; I do not recollect 
having seen any cases of remittent terminate in intermittent, but 
I may have done so. I do not recollect any cases of Yellow Fever 
having terminated in intermittent fever. I am satisfied, however, 
from my researches as to occurrences in various parts of the world 
that it did occur, especially on a certain occasion, I believe, at 
Malaga, as to be found in the work of Arejula ; and this was 
noticed also by Dr. Rush, of Philadelphia, in the great epidemic 
there of 1793, where it was very common. 

Examination of Dr. Gillkrest continued, February 6, 1850. 

I am able, from my own experience, to state that relapses in 
the Yellow Fever of Gibraltar in 1828 were common. Hands 
in a list of cases which occurred in his own corps (43rd) as well as 
in otheis. 

I do not recollect ever having seen a man who had been dis- 
charged from the 43rd hospital cured from an attack of Yellow 
Fever, return from the barracks with a relapse of the disease. 

All my experience in the West Indies in two severe epidemics 
of Yellow Fever, one at Fort Edward, Martinique, 1801, in the 
1st battalion, 68th regiment, lately arrived; the other in the 
^nd battalion, 68th, at Dominique (Morne. Bruce) in the year 
1801 ; also at Gibraltar in 1828; and the result of my deep re- 
flection on the subject, as well as the consideration of its history 
in different parts of the world; goes fully to the strongest convic- 
tion upon my mind of Yellow Fever not being contagious under 
any circumstances whatever. That even crowding of many 
patients together, though perhaps liable to produce other com- 



374 



Evidence of- Dr. Gillkrest. 



plaints, will not produce Yellow Fever. In this respect it resembles 
ague which cannot be produced by crowding. 

In support of this, I refer to documents to be furnished, par- 
ticularly to those which allude to the 69 fatigue men, and to 
servants of the hospital. None of the latter were attacked for 
several weeks after the disease had been treated in hospital. The 
fatigue-men referred to were sent to the number from 1 to 3 
daily to assist the regular servants (orderlies) in the hospital 
duties. 

Promises a document with reference to washerwomen, showing 
that persons washing the clothes of those attacked with the disease 
were not attacked in consequence. Promises a document^ showing 
members of families were not attacked though in communication 
with other members suffering from the disease. 

Promises a document, showing that patients in hospital with 
other diseases were not attacked with Yellow Fever until the 
inhabitants in the immediate neighbourhood were affected with 
the disease. Promises a document with reference to the immunity 
of medical men from the disease until a late period of the epi- 
demic. Promises a document, showing that men on guard were 
exposed to local causes. Promises a document, showing that 
families left the town for the neutral ground with their bedding, 
&c. at a time when some members of them were affected with the 
disease, but the disease did not spread. See Palloni on epi- 
demic of Leghorn in 1804. 

Dr. Gillkrest' s Evidence continued. — February 7, 1850. 

Mentions in favour of the local origin of the disease in Gibraltar 
in 1828, the following case: — Mrs. Farquhar, a respectable lady 
and very old inhabitant of Gibraltar, had a young lady, a niece of 
her's, living with her at a very comfortable cottage in the South, a 
part of the site of which was actually cut out of the rock. This 
niece, I believe, had arrived from England but a few years before. 
Mrs. Farquhar repeatedly told me she had had the disease 
herself in a very severe form in 1804, in proof of which she told 
me she had a glandular swelling in the groin which proceeded to 
suppuration. Her husband also had a disease in the same year 
(1804). She seemed to think that this circumstance rendered 
her insusceptible in 1828; she thought it right, however, on 
account of her niece residing with her, to cut ofi' all communica- 
tion from persons beyond her gates. I was among this number 
of persons excluded. There was some space between the house 
and road, so that no person in the latter could come close to the 
house. The niece, however, was attacked in the severest form 
that could be imagined, and died. 

States that two families in the same house with Trotobas, each 
with double the number of members in their families (eight in 
each) without seclusion escaped the disease. Mentions that 



Evidence of Dr. Gillkrest. ^ 375 



Martinez was, during the time the disease was prevailing, going 
about the town pursuing his occupation, his chief precaution being, 
not going out at niglit. 

Examination of Dr. Gillkrest continued. — • 
FHdaij, February 11, 1850. 

I do not think any orders were given to men of the 43rd regi- 
ment to change their clothes when they returned into their own 
tents from the town. I do not recollect whether the pay Serjeants 
of the 43rd regiment suffered more than other men of the corps. 

Q. How is it that if several elements coexist together sufficient 
to be a cause of a sporadic case of Yellow Fever, that the disease 
thus produced does not spread? 

A. I cannot otherwise account for this, than by it not being 
contagious, and that a very particular susceptibility exists in the 
sporadic case attacked. I may mention that the occurrence of 
scattered or sporadic cases is according to several good authorities ; 
and is of itself fatal to the doctrine of contagion. 

At the time the 68th regiment suffered from Yellow Fever at 
Martinique in 1801, I believe the disease did not prevail among 
the civil inhabitants. I served in the West Indies between 25th 
October, 1800, and 12th February, 1803, during which time I 
saw Yellow Fever epidemically at Martinique and Dominica. 
Again, I served at Gibraltar between 17th March, 1828, and 
November, 1829, during which period I saw Yellow Fever which 
prevailed epidemically in that garrison between August, 1828 and 
January, 1829. 

I think electricity may have something to do with the production 
of Yellow Fever. 

I will furnish on Wednesday next the 14th instant, a copy of a 
report on the subject of Yellow Fever drawn up by me, and which 
contains the various documents alluded to in my oral examination, 
as well as others, likely to be useful to the Board in their 
enquiries. 

(Signed) J. Gillkrest, M.D. 

Inspector- General of Hospitals. 

Dr. Gillkrest re-examined. — February 12, 1850. 

I saw several cases of sporadic Yellow Fever in Gibraltan 
during my service in that garrison. I recollect one terminating 
fatally in the upper part of the town. I do not recollect if there 
was black vomit in that case. 

I saw black vomit in one case ; the patient was a sailor from a 
man-of-war in the bay, and was treated in the Naval Hospital. 
He died. The military medical records of Gibraltar for some 
years past give many other cases, but within the last 25 years 
there have been very few instances indeed compared to pre- 
vious years. At the time the sailor alluded to was attacked, other 



376 Evidence of Surgeon H. Fraser. 

sailors were received into my hospital, from another ship of war 
treated there by my orders. They had yellow skins and other 
severe symptoms, but no black vomit. These cases had remissions, 
some perhaps had not. I do not recollect. 

The ship from which the fatal case was received came direct 
from England. The disease did not spread to any persons in the 
hospital nor to the medical officers. 

(Signed) J. Gillkrest. 



Evidence of Hugh Fraser (H.P.) Rifles. — 
February 12, 1850. 

I saw Yellow Fever in Gibraltar in 1828. Never saw the 
disease on any other occasion. I have seen remittent fever in tlie 
Ionian Islands and Canada. I consider remittent fever and Yellow 
Fever to belong to the same family of diseases., viz., to those occa- 
sioned by terrestrial malaria, in the extended meaning of the 
term ; but 1 consider the cause of remittent fever must be somewhat 
different in power to that which gives rise to the more continued 
form of the disease known under the name of Yellow Fever. 

I am not prepared to offer any opinion whatever as to what 
this cause is. In the remittent fevers which I observed in Santa 
Maura the remissions were very distinct. I think I saw about 12 
cases, and these only after the disease had existed for three days, 
they having been sent from Santa Maura to Zante for treatment. 
The remissions 1 state as having been present were characterized 
by an abatement of the febrile symptoms, lasting sometimes nine 
hours, and followed by marked exacerbation of fever, not always 
with rigors, but generally chilliness. They occurred sometimes 
daily, at others every second day. Of these twelve cases, four or 
five I think, proved fatal, between the sixth and tenth da}' . In 
these cases, in no instance did black vomit appear before death ; 
the matter ejected from the stomach was chiefly composed of 
ingesta. 

Generally speaking, the stomach in these cases was irritable, 
with great tendency to vomit. I cannot recollect that I ever saw 
any bilious fluid vomited. The fecalent discharge from the 
bowels, which were generally relaxed, was dark coloured. The 
dark colour appeared to arise from blood or diseased bile. Tiie 
vessels of the stomach of the fatal cases were turgid. The mucous 
coat was pulpy, softened, and more vascular than in a healthy 
condition. This vascularity occurred in patches, especially about 
the two orifices. No abrasions or destruction of parts were ob- 
served. Stomach was generally empty. I do not recollect that 
any fluid was contained in the stomach. The liver was generally 
engorged. When cut it was softer than natural, and blood was 
generally discharged in considerable quantity. The colour of the 
viscus was generally dark. The spleen generally enlarged, sub- 
stance softened. I do not recollect that any of the twelve cases 



Evidence of Surgeon H. Fraser. • 377 



terminated in intermitfent^ but I have had cases from Santa 
Maura labouring under intermittent, which had been preceded by 
remittent. 

Hemittent and intermittent fever are common diseases in the 
Ionian Islands. 

I should not say, as far as my experience goes^ that these 
diseases are fatal diseases in these islands. 

In 1831 a severe form of remittent fever had prevailed near 
the falls of Niagara,* but had ceased there before I arrived. 
Anxious to make myself acquainted whh the disease, and hearing 
that it was still prevailing along the banks of the river at 
Buffalo in the United States, about twelve miles from Niagara, 
I went there ; and from what I saw and heard from private 
practitioners there, T was inclined to consider the disease as 
identical with the fever that prevailed in Gibraltar in 1828. I 
saw there cases of. decided remittent fever, and others which 
showed no remissions, only a slight abatement of the febrile symp- 
toms^ followed by an exacerbation of fever. I considered some of 
these cases as having presented the same characters as the disease 
in Gibraltar did, though it is impossible to describe what they 
were. I saw no instance of black vomit, but was told that several 
had occurred. The private practitioners distinctly told me thev 
considered the disease then at Buffalo was the Yellow Fever of 
the American continent. This occurred in the latter end of June 
and July. The disease broke out immediately after the breaking 
up of the frost. A number of people residing between Niagara 
and Fort Erie, on the English side, were attacked. From Fort 
Ej-ie it extended itself to Bufi'alo. 

I remained at Niagara for three or four years, and during that 
period I do not recollect having had any soldiers in hospital suffer- 
ing from intermittent or remittent fever. I did not witness either 
disease in any other part of Canada. 

I consider the remittent fevers at Buffalo to have all had their 
origin from one and the same cause, that cause differing only in 
power. I do not consider that a person having one attack of 
remiitent fever derives therefore an immunity from a second attack 
of remittent, but rather that it predisposes to an attack of inter- 
mittent fever. I consider that one attack of Yellow Fever gives 
a very great protection to the individual attacked, from a second 
attack of Yellow Fever, but, perhaps, not more so than in typhus 
fever or cholera. At present I do not consider typhus fever to be 
a contagious disease. I consider no diseases to be contagious, 
except the Exanthematous diseases, and they, not to the extent 
that is generally believed. I knew several cases of persons suf- 
fering from Yellow Fever in Gibraltar in 1828 who had suffered 
from the disease in that garrison in previous years. The proof 
of this v/as the testimony of the persons attacked. The popu- 

* Lundy's Lane. 

2 c 



378 



Evidence of Surgeon H. Fraser. 



lation generally was under the impression that one attack saved 
them from a second. I served in Gibraltar between 1823 and 
18i9. I never saw, during this period, any cases of remittent 
fever, so decidedly of a remittent character as those that occurred 
at Santa Maura and Buffalo. I saw cases of intermittent fever, 
but T can.iot say they originated on the rock. Along the coast of 
Spain I occasionally saw cases of remittent and intermittent fever, 
particularly at the first river from Gibraltar on the eastern coast. 
The country in this direction was marshy. I never saw anything 
in the epidemic of Gibraltar in 1828 that led me to believe the 
disease was contagious, but the contrary ; during the prevalence 
of the disease my wife, wife's sister, and female servant resided on 
the neutral ground, where I slept occasionally and visited fre- 
quently. None of them were attacked with the disease. I was 
taken ill towards the end of the epidemic; my wife, against my 
wish, got into town and attended upon me ; in two or three days 
she was seized with the disease in a severe form, still was con- 
valescent in the course of a week. Mentions another case, Lieut. 
Werge, 12th regiment, was quartered in the neutral ground, 
was attacked there, was treated m my house in the Civil Hospital, 
became convalescent, returned contrary to my wish to the neutral 
ground; went and drank tea with Mrs. Fraser; had a relapse 
while with her, vomited black matter in the tent, and returned to 
the Civil Hospital, where he died. This was more than two 
weelxs before Mrs, Fraser was attacked. 

The liver in fatal cases of Yellow Fever was of a fawn colour. 
(Promises a document, giving particulars of the morbid ap- 
pearances of the disease.) Several cases of relapse occurred even 
^vhen individuals had been two or three weeks out of hospital. 

Convalescence generally, was rapid and perfect; leaving no 
organic diseases behind, as far as 1 know. 

Maria Piscadina, my servant, was attacked with fever on 3rd 
August, before the disease was declared as established. She had 
irritability of stomach and yellow skin, but I did not consider it a 
serious case, otherwise I should have sent her to hospital. I did 
not require to get another servant to do her work. She recovered, 
and some time after had a second attack rather more severely. 
Both attacks occurred in the month of August. 

The disease generally ran its course rapidly ; if the patient got 
over the third day into the fourth he generally recovered, and was 
convalescent about the eighth. No precautions, I believe were 
taken by the medical men in Buffalo to prevent communication 
between the healthy and sick on the presumption that it was an 
imported disease. 

I consider sporadic cases occurred in Gibraltar between 1823 
and the breaking out of the epidemic in 1828; some of which 
were fatal. 

(Signed) Hugh Fraser, 

Half-Pay Surgeon 60t/i Rifles. 



Report of Dr. Barrel! to the Privy Council. 379 



REPORT of Dr. Burrell to the Lords of the Council, on 
the reasons for the opinions delivered by him as Member of a 
Board of Inquiry, held at the Office of the Army Medical 
Department (1849-50), on the subject of Yellow Fever.* 



As A MEMBER of a Board, assembled by order of his 
Grace the Commander-in-Chief to investigate and give an opinion 
on the following points^ viz. : — 

1st. Does the Yellow, or Bulam Fever, differ from the Marsh, 
or Remittent Fever, of warm climates, or is it the same fever in 
a more aggravated form ? 

2nd. Does an attack of Yellow or Bulam Fever give, like 
small-pox, an immunity from a second attack, except in very rare 
instances ? 

3rd. Is Yellow or Bulam Fever a contagious disease ? 
4th. Is it capable of being imported ? 

I consider that the weight of testimony, both oral and docu- 
mentar}^, brought forward in the course of this inquiry, as well 
as a careful examination of the whole subject, will fully warrant 
me in submitting the following observations. 

I BELIEVE Yellow Fever to be the most concentrated grade of 
fever in all countries capable of generating it, — to be closely allied 
in its nature and causes to the ordinary fevers, more especially in 
the Antilles, whether the type of these be remittent as in 
Jamaica, or continued as in Barbados, — and not to be more 
peculiar or less indigenous to the latitudes in which it commonly 
occurs, than the common continued fever is to this country. 

The form of Yellow Fever, or that attended by black vomit, 
which has been assumed by some as the only true model of the 
disease, acquires this pre-eminence over the ordinary fevers of 
the West Indies from the presence of the European, whom it 
attacks with a frequency and certainty in proportion to the 
shortness of his residence. In the absence of such subjects, the 
advocates of the Bulam being a distinct disease, might safely be 
challenged to produce any considerable number of cases exhi^ 
biting the peculiar group of symptoms and mode of termination 
which, in their opinion, are suffi.cient to distinguish it from the 
ordinary fevers of the country, and to mark it as an essential and 
separate disease. 

Sickly or epidemic seasons, involving the whole population,- 
occur in the West Indies, as in Europe, and very often at the 
same time of the year, and in these the new comer shows with 
more certainty his appropriate and peculiar grade of the disease ; 
but it is very certain that ordinary or healthy seasons to the 

* Dr. Burrell was the only member of the Board called on by the Lords of the 
Council to state the reasons on which the opinions delivered by him on the occasioa 
were founded. 



380 



Femr in the acclimated 



natives are often to him the reverse ; his constitutional suscep- 
tibility appearing to compensate the want of power in the cause ; 
and in consequence, many of the partial and irregular outbreaks 
of the disease are confined to this description of subject. 

It would appear, the eruption of black vomit fever in the 
West Indies does not there, as in Europe and the more northern 
States of America, require always the same, or nearly the same 
season, or that occasional epidemic inflaence which seems to be 
necessary to its wide-spread invasions of countries beyond the 
tropics, and nearly, if not always, at the same season. In other 
T/ords, while there are causes almost constantly present, capable 
of producing the disease with new comers in the West Indies — 
not to be explained by the importation of contagion — some occa- 
sional and peculiar constitution of atmosphere would seem to be 
indispensable to its development in Europe. 

Yellow Fever, like the fever that devastated the Imperial 
army in Hungary, the Walcheren fever, and other well known 
outbreaks of disease among troops, has always been the scourge 
of armies, leaving the natives comparatively unscathed; the 
int^se cerebral and gastric disorder, the haemorrhages and other 
formidable symptoms, and irregular and uncertain invasions of 
the disease, having usually, like them, been reserved for the 
stranger ; and I conceive we are here forced to one of two con- 
clusions, either that the susceptibility of the stranger is the 
occasion of the more intense operation of causes producing in the 
natives a very mitigated disease, or that, for some inscrutable end, 
he alone is singled out as the victim of a malady depending on 
causes not only specifically diiFerent from those affecting the 
natives, but as fluctuating as his migrations. Is it credible that 
the black, and even the bulk of the coloured population in 
the West Indies, who suffer from putro- adynamic fevers, and all 
other diseases assailing the white races, should not in some form 
present a disease indigenous to their country ? To say they have 
it in their youth, and in a much milder form, is to fall back to 
the ordinary fevers of the country, and to relinquish the only 
diagnostic — the black vomit, by which any line of demarcation 
can be drawn ; in fact, to admit that the mild continued, or re- 
mittent, are the forms in which the natives present the Bulam. 

The coloured population, and the acclimated European, rarely 
present the disease in the intense form in which it attacks the 
new comer ; they usually only suffer from the remittent or inter- 
mittent, and are sometimes entirely exem.pt at periods when the 
stranger is the solitary victim of the Bulam ; a fact replete with 
instruction, if the blindness of theory would permit us to apply 
it. Nothing, I am convinced, can explain this anomaly, but the 
greater susceptibility of the stranger to the noxious influence of 
a climate to which the others have become assimilated, the op- 
portune arrival of contagion at the period he is known to be 



compared icith the newly arrived. 



381 



most obnoxious to the baneful effects of that climate, being a 
conception too improbable to be entertained. 

We appear to have selected the disease of the stranger, who is 
the least suited to represent the diseases of a country, either in 
the character or degree of their symptoms or pathological coii- 
ditions. We should not consider as a fair representation of the 
diseases of this country, and their fatahty, the results which might 
follow the exposure of the natives of the tropics to its cold, and 
vicissitudes ; why, then, should we take our distinguishing mark, 
our point of departure in diagnosis, not from the essential 
features of the disease as it occurs in the natives of the West 
Indies, but from an occasional symptom, the exudation of dis- 
solved blood in the stomach, which is scarcely known, in an 
epidemic form, but with Europeans? The wide spread and 
malignant fever that assailed the troops at Walcheren, would be 
no measure of the forms in which it attacks the natives. Let us 
not believe there is one cause and one disease for the stranger, 
and another for the native ; they suffer under very intelligible 
modifications of the same disease. " The French," says Dr. 
Fergusson, "have defined it (the Yellow Fever) in one word, 
^ la Jievre Europeeniie wel for us had we stuck to this true 
definition, for it would have saved an infinity of controversy, 
panic, and delusion." 

We are told by McLean, that so new was the disease to the 
French physicians in St. Domingo, that they ascribed the mor- 
tality to the ignorance and inefficiency of the English doctors. 
The ultra-contagionists say that the disease spread to the several 
islands after the arrival of the ship Hankey," and the outbreak 
of the disease in Grenada in 1 793, when, in fact, as subsequent 
sad' experience has proved, this coincidence was entirely attri- 
butable to the diffusion of fresh European subjects direct from 
England ; and such has been the almost uniform history attending 
the influx of new comers, whether of the army or navy, up to the 
present day. 

Of 30 regiments that arrived in the Windward and Leeward 
Islands between 1816 and 1848, 10 were attacked with black 
vomit fever a very short time after landing; 2 w^ithin three 
months ; 1 1 within twelve months ; 5 within two years ; and 2 
wdthin three years of their arrival. Of 13 regiments which 
landed in Jamaica between the years 1816 and 1834, 4 were 
attacked within six months ; 7 within twelve months ; and 2 
within eighteen months. From 1838 to 1848, 7 regiments 
arrived in that island, but the emancipation of the negroes per- 
mitting the troops to be quartered in the mountains, a few cases 
only of black vomit fever appeared, within that period, in two of 
them soon after landing. 

Between 1834 and 1838, no new regiments arrived in Jamaica, 
and during this interval there v/ere very few black vomit cases^ 



382 Sporadic Cases amoiig Strangers. 

and those chiefly among recruits. Of 40 regiments in the 
Windward and Leeward Islands, between 1816 and 1848, I can 
only find 10 which have not suffered from the black vomit variety 
of Yellow Fever, to a greater or less extent; none escaped in 
Jamaica which were quartered in the lowlands. In both com- 
mands, out of 53 regiments, 33 were attacked with black vomit 
fever within twelve months after their arrival ; showing pretty 
accurately that we do not require the importation of the disease, 
but the arrival of the stranger for its development at almost any 
time or season in the West Indies. I have good grounds for 
stating that sporadic cases of the disease are of nearly annual 
occurrence among new comers in Jamaica, and in pretty accurate 
proportion to their numbers, and their indiscretion as to exposure, 
fatigue, and excesses of various kinds; causes, it may be re- 
marked in passing, very unlikely so repeatedly to call into 
existence the alleged specific contagion, from which alone Yellow 
Fever has by some been considered to arise. Instances of the 
very general suffering of new comers to the West Indies could 
be easily multiplied, but the fact is too notorious to require 
further illustration. 

Cases of the ordinary endemic fevers, whether the bilious 
remittent, or continued, are very constantly found existing with 
Yellow Fever, in greater or lesser numbers, and up to the appear- 
ance of what are considered mortal symptoms ; passive haemorr- 
hages and black vomit ; those terminating in this way are either 
with difiiculty, or in some instances not at all distinguishable 
through one half, or sometimes three-fifths of their course, viz., 
the stage of excitement, from many cases of the ordinary 
fevers. 

In what are called sickly seasons in the West Indies, the 
ordinary fevers are often found to precede, accompany, and 
follow invasions of Yellow Fever, and cases of both varieties 
may be found at the same time, in the same community, and even 
in the same family, under parallel exposure and other hygienic 
conditions save one, the unassimilated European constitution ; 
the best test, sometimes the only infallible one, of the presence 
of causes productive of the Bulam; and it is opposed to the 
general history of medicine and of epidemics that two fevers, up 
to a certain point of their course, so nearly approximated in 
symptoms, in theit rise, progress, and decline, should be con- 
sidered as radically dissimilar in their cause and essence. 

Yellow Fever, and the more severe varieties of fever, in all 
places north of the tropic of cancer, are as decidedly gastric, as 
the fevers of the eastern hemisphere are cerebral, in their 
character; yellowness of surface, haemorrhages, and often an 
unclouded intellect are also as common and peculiar to the one, 
as the very general absence of these are to the others; and it 
appears to me, though practically warranted, we should be 



Analogy of Epidemic icilh ordinary Fever. 38-3 



pathologically as little correct, in attempting to dra\r a line of 
separation at every unusual and excessive amount of cerebral 
affection and mortality in the one, (which has never been 
attempted) as in excluding from their equally legitimate family, 
an occasional series of cases remarkable for high gastric disorder, 
in the other. These are climatic peculiarities not to be trans- 
plantedj and furnish, it may be here remarked, a much more 
intelligible explanation of the restriction of Yellow Fever to 
certain geographical boundaries, than that ships never proceed 
direct to India from the latitudes of this disease. The practical 
physician in the East has never sought a separate nosological 
position for any grade of fever, however differing in form and 
fatality from that usually prevailing, and nothing, it appears to 
me, could ever have elevated black vomit fever into a distinct 
disease, but the circumstance that the doctrine of contagion 
would not accord with the class of fevers with which it is so 
obviously allied. 

To regard the Bulam as a distinct disease is a postulate quite 
indispensable to carry out the doctrine of Chisholm and his 
followers ; but I question how far it is tenable with those w^ho 
refer the disease to local causes. Here there is still assisrned to 

o 

it a generic peculiarity, not less decided than that assumed by 
the contagionists, and not to be maintained without inferring a 
distinct and separate local cause from that producing the ordinary 
fevers — a cause as fluctuating and contingent as imported con- 
tagion ; for although an epidemic, or some superadded influence, 
may be necessary to account for such wide-spread invasions as 
those of Spain, &c., we cannot doubt, when we find the civil 
population entirely free, as in Barbados, in 1847-48, and on 
several other occasions, that the disease may spring up among 
new^ comers from ordinary causes, without the apparent aid of 
any such influence. 

On the supposed universally continued type of the Bulam, its 
more concentrated form as a whole, its more rapid course, and 
generally greater mortality ; the frequently pale colour of the 
liver, and the termination in black vomit, which has been exalted 
into a pathogonomonic symptom by some, (all, in my opinion, 
entirely reconcileable with a more intense febrile action in the 
description of subject to which in the West Indies it is almost 
peculiar) chiefiy rest the grounds for the attempted elevation of 
an occasional grade into a generically different disease. 

Black vomit, which must be looked upon as a peculiar termi- 
nation, not a s^-mptom, for it does not occur till a late period of 
the disease, is the principal characteristic of the Bulam ; and the 
absence of which is sufficient with some to exclude all other 
forms, however closely approaching it in all the leading features. 
Thus, as Dr. Bancroft says, " selecting " a form of the disease 
almost peculiar to the unacclimated, and attempting to assign to 



384 



Black Vomit — Convalescence. 



the most varied of fevers, whicli, according to Cliisholm, would 
require the ^' fidelity of a Claude Lorraine to delineate," a 
character more defined and circumscribed in its phases and 
phenomena than plague or typhus ; and yet so little specific or 
uniform is it sometimes in duration and mortality, that after 
exhibiting its usual symptoms and rate of mortality, we find it 
changed, as in the ships Hussar," and " Chichester/' to a com- 
paratively mild disease, marked by a long and uninterrupted 
succession of recoveries, and that simply by a lower temperature, 
which has never been known so completely to change small-pox, 
or an})- other contagious disease, with which it has without the 
slightest foundation, in my opinion, been compared. 

The appearance of black vomit during life occurs more fre- 
quently and in greater quantity in the Yellow Fever of the 
West Indies, than in that of Gibraltar ; for according to Dr. 
Gillkrest, of 190 cases of the epidemic of 1828, only 6 vomited 
this matter during life. The disease altogether would appear to 
be more rapid and malignant in its course, in the West Indies, 
than in Europe. The afi'ection of the head, and the irritability 
of the stomach are occasionally found to alternate to some extent 
with each other, and where the former predominates much, 
the black vomit is sometimes absent. Dr. Davy, in a note to 
Dr. Blair's late work on Yellow Fever, alludes to an epidemic in 
Barbados, in 1811, in which the gastric symptoms were very 
inconsiderable, and the fever at the Island of Edam, described by 
Dr. James Johnson, which approached the Yellow Fever in some 
of its symptoms, may be noticed as another of those occasional 
deviations from the forms common to certain latitudes. 

About the rapidity of convalescence, insisted on by Sir William 
Pym, there is great difference of opinion. M. Louis, and the 
majority, state it to be generally rather tedious in proportion to 
the severity of the cases, several of which do not exceed a mild 
synochus. With such cases, I may here remark, occurring, as 
they generally do, after a short residence, the absence of sequelae^ 
or visceral disease, may be readily understood, and cannot, in my 
opinion, be considered as any proof of a disease different from 
the remittent, which is not always a marsh fever, or necessarily 
followed by tedious convalescence or sequelae, as stated by Sir 
William Pym. 

The leading symptoms of the Bulam, and those of what is 
called the malignant remittent, closely approximate ; they differ 
in the more persistent and intense character of those of the 
former collectively ; but they are chiefly, and sometimes only dis- 
tinguished by the occurrence of black vomit among the ultimate 
phenomena of the Bulam ; a contingency, or as it has been more 
happily termed, " the accident of a season," not, in my opinion, 
essential, or sufiicient to disjoin them as radically dissimilar; the 
cerebro -gastric affection, the yellow suffusion in more or less 



Symptoms — Morbid Appearances. 



385 



intensity, the irritability of stomacli, suppression of urine, 
haemorrhages, with occasional dark- coloured vomiting and de- 
jections, proclaim, in my opinion, the malignant remittent, as 
being closely allied to the Bulam ; and like it to be frequently 
the highest grade, conditional to circumstances of locality, of 
subject^ and degree of cause; concurrent differences in these 
being equal, as in fever everywhere, to effect endless modi- 
fications. 

With the exception of a pale, orange yellow, or nutmeg colour, 
and according to O'Halloran and some others, a dry or exan- 
guious condition of the liver, appearances by no means constant, 
there is not a morbid alteration in the Bulam, that is not found in 
what the ultra-contagionists would call the malignant remittent, 
not approximating merely, but in absolute amount, sufficient, in 
the absence of black vomit in the stomach, to annihilate all means 
of distinction. 

Remittent fever, the most common type in all intertropical 
regions, is not necessarily the product of marshy, or even of 
humid localities, it occurs where marsh cannot be suspected, and 
is not necessarily a grade of, or followed, as some assert, by inter- 
mittent fever or ague. On the contrary, the remittent is found 
in places where ague is never met with ; thus showing the fallacy 
of attempting to connect, as a rule, the type of fever with the 
surface soil, or humidity of a place ; Kingston, Up Park Camp, 
Port Royal, and according to Pergusson, the volcanic surface of 
Baiiiffe, in Guadaloupe, often giving rise to the same kind of 
fever as that at Spanish Town, Falmouth, Montego Bay, and 
other localities, notoriously paludal in their character. As far as 
relates to ague, we are able to connect periodicity in fever to 
some extent with swamp ; but here we must stop : the remittent 
type being nearly universal in all intertropical countries, whether 
dry or humid. 

In protracted cases of acknowledged black vomit epidemics, 
distinct remissions are frequently observed ; and cases presenting 
the remittent form frequently precede, accompany, and follow 
cases of the Bulam in the same regiment, under similar hygienic 
conditions. Without therefore maintaining that the Bulam is 
always of remittent type, it is fairly to be inferred that it is fre- 
quently so, and only fails to show remissions from the violence 
and rapidity of course of the disease. 

The form and train of phenomena marking the Bulam are 
often grafted on pure remittent, and intermittent fevers, more 
especially in hot and humid places — a fact corroborated by nearly 
all whose field of observation has lain there ; and it would be, in 
my opinion, in the present state of our knowledge, to assign a 
very subordinate agency to so powerful a febrifacient cause as 
malaria to call this a complication ; it is too constant in some 
localities to be accidental. On the other hand there are equally 



386 



Various Types of the Disease. 



accurate and unbiassed observers "who maintain tbat the Bulam 
is alwcvys continued in type, and so strong and irresistible to me 
are the facts in support of both views, that I am forced to 
believe that the type of the Bulam varies in different localities, 
and is not essential to the disease, or, at least, not to the pro- 
duction of the ultimate phenomena by which it is characterized. 

Dr. Bone, Inspector-General of hospitals, who had long and 
extensive experience in the West Indies, speaks of what he 
calls the occasional " marsh basis " of Yellow Fever, and Dr. 
Chisholm must have observed a good deal of the remittent form 
in his " Nova Pestis," when he called it a compound of that 
and typhus. " Lempriere describes a remittent Yellow Fever. 
But on this point I consider the following conclusive : " I have 
just stated," says Dr. Bartlett, of Transylvania University, in his 
work on Fevers, " that Yellow Fever, like other diseases, pre- 
vailing in malarious regions, may sometimes assume something 
of a periodical character. This subject deserving of further 
investigation has recently been studied by Dr. Lewis, of 
Mobile. He has described a form of the disease which he calls 
remittent, and intermittent. Yellow Fever. During the epi- 
demic of 1843, at Mobile, simple remittent fevers prevailed 
extensively in the southern part of the city, mostly among the 
natives and acclimated population. Dr. Lewis says that he at- 
tended in this district of the city 16 cases of the remittent, or inter- 
mittent fever, assuming the rank and grade of Yellow Fever. 
These cases were all among the unacclimated. Dr. Lewis estimates 
the number of these cases, during the epidemic of 1843, at 100, 
50 of which terminated fatally. He says, the intermittents were 
more fatal than the remittents. With the exception of the 
periodical element, the disease in these cases did not differ from 
the ordinary unmixed forms of Yellow Fever ; it went regularly 
through its several stages, terminated in its usual manner, and at 
its usual periods." 

" Of 28 cases of fatal intermittent Yellow Fever, all terminated 
within the seventh day from the initial chill. Dr. Lewis does 
not give any full description of these cases, but there is no 
reason whatever for doubting the correctness of his conclusions. 
He is a competent and trustworthy observer, and he is in no 
way influenced in his opinions by preconceived prejudices or 
notions, since he recognizes, without any qualifications, the 
essential dissimilarity of periodical and Yellow Fever. In 
another paper. Dr. Lewis mentions particularly seven cases oc- 
curring in 1842, which he calls congestive, simulating Yellow 
Fever. They occurred in persons who had been living in ma- 
larious regions, and were marked by the symptoms of congestive 
and of Yellow Fe-sfer." 

Dr Lewis says : — 
The pathological appearances of the congestive fever of the 



Influence of Locality. 



interior, and the Yellow Fever of Mobile, were both apparent in 
these cases, so that, taken in connection with the symptoms before 
death, they constituted a perfect example of the blending together of 
the different febrile poisons, so as to produce a disease of mixed 
character. 

" Dr. Dickson, formerly of Charleston, South Carolina, now in 
the University of New York, admits explicitly and distinctly 
the existence of this modified form of Yellow Fever :" — 

" In the summer of 1817," (he says), " many northern and foreign 
sailors had been induced to go as boatmen up our rivers. Considerable 
numbers of them were brought into our hospitals with country fevers 
both remittent and intermittent, which as soon as Yellow Fever 
became prevalent, ran into that epidemic ; the fever becoming con- 
tinued, and black vomit ensuing." 

It is very evident that the causes of Yellow Fever are present 
in places of very different character, not only as regards the 
temperature and humidity, but in vegetation, soil, and the 
commonly supposed sources of telluric miasm. These dif- 
ferences apparently lead to marked varieties in the forms of 
the ordinary fevers, and if these are allied, as I believe they are, 
to the highest grade or Yellow Fever, it is questionable how far 
the disease is everywhere the result of the same cause, as has 
been insisted on by Bancroft, Fergusson, and others, or whether 
different causes, such as may be supposed to exist in places so 
different as Gibraltar ; Jamaica ; Brimstone Hill, in St. Kitts ; and 
on board ship ; may not in fever as in the phlegmasiae, give rise 
to similar ultimate effects ; for I think nothing can be more 
certain, than that the most perfect representation of some forms of 
Yellow Fever is to be found in the Algid variety of intermittent, 
a form of fever which Gibraltar is considered incapable of pro- 
ducing. 

There are but two uniform and appreciable conditions which 
we can connect with the eruption of Yellow Fever in the West 
Indies — heat, and the unassimilated European constitution. All 
further attempts to connect the disease with soil, surface, dryness, 
humidity, or sources of malaria, fail to assist us ; for wherever 
soldiers may be placed, whether in the driest locality, or in a 
marsh, or under the most favourable circumstances as to barracks 
and discipline, they rarely escape the disease. 

I have shown that high gastric disorder is the prominent 
characteristic of all severe fevers of certain latitudes, as marked 
cerebral determination forms that of the fevers of Ceylon and the 
whole continent of India, and the irreconcileable contradictions 
and anomalies with which the subject of Yellow Fever is beset, 
would seem to point to the conclusion that fever once excited, 
climate, the latitude of that climate, and the other conditions 
under which it occurs, rather than the continued operation jce?- se 
of any uniform specific cause, tend in some of its more concen- 



388 



Modifications of the Disease. 



trated and fatal forms to a common and similar train of ultimate 
phenomena. 

We can scarcely, I think, doubt that efficient and similar 
elements for the production of fever are to be found in all inter- 
tropical countries, and yet, with slight occasional deviations, how 
constantly it takes on the form common to the latitude in which 
it occurs ; and nothing confirms me so much in the opinion of 
Yellow Fever being a grade, as its absence from the eastern 
hemisphere, and its close resemblance in the organs affected to 
all the severe fevers, especially those of malaria, in all places of 
a certain temperature north of the tropic of cancer. 

In the absence of the European constitution, the Bulam form 
of Yellow Fever would probably be as unfrequent in the West 
Indies, as in Europe, and that in a much less concentrated form. 
But the occasional absence of the highest and most fatal grade 
of a disease, will not disprove the presence of more mitigated 
forms of that disease, and of the causes on which it depends ; 
and I conceive we may, with equal justice, maintain, that common 
continued fever and its causes are absent from this country, 
because we have not at all times those wide spread, destructive, 
and peculiar forms of the disease, which occasionally show them- 
selves, as that Yellow Fever does not admit of any lower grade 
than that marked by black vomit. 

Fever differs in grade and in form, and often in type, in 
different islands of the West Indies, and in different localities of 
the same island, and the features of one are so often blended 
with those of another, as almost to defy classification, proving 
the truth of Dr. Percival's remark, " that those who are most 
familiar with the aspect of fever, on the large scale, will be least 
disposed to subdivide it into genera." 

In 1S34 in Malta, the regiments in garrison had more than the 
usual number of fevers, all of a remittent character, and in two 
of them from 20 to 30 cases occurred, presenting great irrita- 
bility of stomach, yellowness of surface, hsBmorrhages, sup- 
pression of urine, and death in several cases. In the other 
three corps, there was not a case of this kind, nor a single death. 
Now will it be contended that these cases were a totally dif- 
ferent disease from that affecting the majority, not only of the 
sarrison, but the majority of the two regiments in which these 
peculiar cases occurred. In the late epidemic in Barbados, the 
72nd Eegiment* was supposed to be free from black vomit fever 
for seven months ; while tv/o other corps were suffering from 
that form of disease in the same garrison, because, during that 
period, they had only a few cases, monthly, of a mild fever 
without a death. Now I ask where is the proof that these mild 
cases were not identical with the fever, which, from a more 



* See Dr. Gillkrest's Report, Addenda K., p. 226, [G, M, H,] 



Range of Symptoms. 



389 



intense degree of the same cause, was proving fatal in tlie other 
regiments. The symptoms essential to fever are few, and the 
Bulam, according to Sir William Pym^ cannot in the beginning 
be distinguished. The absence therefore of the ultimate phe- 
nomena, and death, which depend on adventitious causes of ag- 
gravation, will by no means disprove the identity of the two 
fevers ; and I am the more disposed to this opinion from the 
circumstance, in many of the epidemics of Yellow Fever, of 
cases of great malignancy coming from certain suspected places, 
or crowded rooms, and mild ones from others, as if inconsider- 
able local differences were sufficient to exalt a very mild fever 
into the most concentrated and fatal. 

With a knowledge of the kind of subjects in whom the Bulam, 
and the remittent, occur respectively, are we to include in the 
category of the former, those cases only, that by peculiarity of 
constitution, or greater intensity of cause, occasionally stand out 
in relief by increased mortality and a single superadded hoe- 
morrhage ? I think not. No disease, Dr. Gillkrest says, has 
a wider range in symptom, and none, I may add, is less uniform 
or determinate in its attributes generally, than Yellow Fever ; 
the epidemics of different years, and in different places, and the 
same epidemic at different periods, varying considerably, not 
only in symptoms, in degree of malignancy, and rate of mor- 
tality, but even in form and type. This has been more especially 
exemplified in some of the invasions of the disease in Jamaica, 
and the Mediterranean, in which last place, at the outset of epi- 
demics, great diversity of opinion has prevailed as to the appear- 
ance of any new disease, and which, at length, seemed to be 
decided by the increasing number of cases, rather than by any 
marked difference, for a time, from the ordinary fevers. This, 
while showing the similarity of the disease with the ordinary 
fevers, proves a much greater capability of modification and 
grade than some will admit it to possess. 

The year 1825, one of universal sickness in Jamaica, as well 
among the military as the civil population, offers much deserving 
of notice, not only as to the varied character of Yellov/ Fever, and 
its close approximation at times to the remittent form, but the 
modifications it undergoes by locality, length of residence, and 
weather. 

The 77th Regiment stationed at Stoney Hill, and 1 1 months 
in the island, became sickly in the beginning of February, and 
the fever is described at this period by Dr. Kichardson, as 
follows : — • 

" The first symptoms of the disease were violent headache, commonly 
confined to the fore part of the head ; severe pains in the lower part of 
the back and loins, and also in the limbs, especially in the calves of 
the legs ; great prostration of strength, anxiety, restlessness, and not 
unfrequently nausea and retching, in some patients of a colourless, in 
others of a greenish fluid. 



390 



Varieties of Type 



" The skin was hot, face flushed, eyes florid, hut not watery^ nor 
having the peculiar expression so remarkable in the disease some 
months after; puise pretty full and frequent, from 96 to 120. 
Hitherto the appearance of the tongue was various, in some patients 
it was clean and florid from the commencement, in others covered with 
whitish or yellowish mucus ; the bovvels usually constipated, the 
urine highly coloured, and scanty, but in some quite limpid and in- 
odorous. 

" After the first 12 or 14 hours there was generally an amendment 
of all the symptoms, or more properly speaking, a considerable re- 
mission, but this was of short duration. An exacerbation of fever 
soon followed with a return of headache, but not severe after the first 
paroxysm was over. 

" The worst symptom, if it had not been present from the beginning 
of the disease, now supervened, viz., irritability of the stomach, and 
unless the febrile symptoms were again speedily relieved and subdued, 
this symptom rapidly advanced till disorganization of the stomach was 
effected, when the case soon terminated in black vomit. 

" I have already stated that, the first case of the epidemic was ad- 
mitted into hospital on the 1st February, and from that to the 21st of 
the month, the number of admissions amounted to 35, of which number 
seven died. During this period the disease was one of considerable 
excitement and of pure remittent tyjoe, 

" On the 22nd February seven cases of fever were admitted into 
hospital, all of them very bad, and from this date up to the 26th March, 
the admissions continued at the rate of six a-day on an average, so that 
in the short space of 33 days we had admitted 198 men into hospital, 
besides an equal proportion of officers, women, and children. 

" During this period the epidemic continued to preserve the re- 
mittent type, but the remissions gradually became shorter and less 
distinct as the dry season advanced, and the symptoms progressively 
assumed a more dangerous character. 

" The fever now was not one of excitement, but quite the contrary, 
great nervous depression marked its commencement and progress, and 
iti was evident the first influence of the miasmata was exerted directly 
upon the nervous system. The attack became more sudden, and it 
was no unusual occurrence for a man who felt perfectly well on going 
to bed, or in the morning at breakfast, to be prostrate with the disease 
in less than half an hour." 

Here Dr. Richardson gives an admirable description of the 
symptoms usually attendincy the most aggravated form of the 
disease, and continues as follows : — 

" The pulse, in some instances, I have found preternaturally slow, 
but the general state of the pulse, on admission, was small, soft, and 
frequent, numbering from 100 to 130, but rarely giving much resist- 
ance to tlie finger on pressure. 

" The tongue in the worst cases was clean and dry, but in others 
rather moist and covered with whitish or yellowish mucus towards the 
centre. 

* * * "A general torpor and derangement pervaded the secre- 
tory organs and membranous stiucture, especially of the stomach, 
where a disorganizing principle was always apparent, and indicated by 



dur ing the same Epidemic. 391 

a painful burning sensation in that organ at an early period of the 
disease. 

" Irritability of stomach is a very common symptom in endemic 
fevers, in that, under review, it was an invariable attendant. 

" The proportion of mortality during this period was one in four of 
the number admitted. 

From 26th March, to 10th May, 80 cases were admitted ; the 
mortality in these admissions was 21. 

*' While the dry weather continued the epidemic gradually increased 
in violence, becoming more of the continued type ; the heat more 
ardent ; pulse weaker and more frequent ; a greater degree of debility 
from the commencement of the disease ; * * * * tJie tendency to the 
dissolution of the stomach greater, which was indicated by the state of 
the tongue early assuming a leaden, scammony colour, and gradually 
changed to black. Haemorrhage from every orifice was 7iow a frequent 
symptom, and very often carried the patient off when fever had been 
subdued. The disease was now more rapid in its progress, and the 
system could, with more difficulty, be affected by mercury. 

" About the middle of April the rains began to fall, and increasing 
about the middle of May, the epidemic disappeared, and from the 
11th of the month to the 1st of June, there was not a death in the 
hospital at Stoney Hill. 

From the 1st to 18th July, there were only four deaths from fever, 
so that from the 11th May, to 18th July, the deaths from fever only 
amounted to eight, and two from dyi^entery, thus proving the salutary 
effects of rain at Stoney Hill, and it was not until after the continuance 
of six weeks dry weather that we began to be sickly again. 

" The number of admissions from 18th July, to 8th September, (of 
fever) amounted to about 200, of which number 57 died, the greatest 
proportion of mortality experienced throughout the year. During the 
month of August the disease was of a more ardent character, and of 
continued type ; * * * the disease now ran its course more rapidly, 
and was more uncontrollable than at any former period." 

The above will show how little defined Yellow Fever is, either 
in grade, symptom, type, duration, or rate of mortality, and the 
power of weather and season to modify, arrest, and renew^ its 
virulence. I will now allude to the sickness in the 33rd and 
50th Regiments in the same year, the former three, and the 
latter six years, in the island. 

Dr. King, acting surgeon, 33rd Regiment, states, — 

" Five hundred and fifty-five cases of bilious remittent have been 
treated since the 20th December 1824, of which number 66 died, 
making an average of 1 in 8*4. Since the 33rd disembarked at Port 
Hender>on on 29th September last, no fewer than 223 cases have been 
treated in the hospital at Spanish Town, and of which 43 have died, 
making a proportion of 1 in 5^. 

The disease generally assumed more the appearance of typhus than 
usual, and exhibited all the varieties of intermittent fever. A remark- 
able difference might be observed when quartered on the north side. 
There the disease was frequently combined with arterial excitement, 
and ushered in with general synocha, whilst, on the contrary, the 



392 Form of the Disease as it 

fever at Spanish Town from thxe very beginning assumed a typhoid 
type. There was, however, great variety, both in its progress and 
mode of attack. Two forms of fever might very often be observed, 
the tertian, the quartan, and sometimes quotidian, but the usual form 
was bilious remittent. 

When the remissions became less remarkable, the febrile anxiety 
and restlessness increased ; the patient is unable to sleep and complains 
of thirst, which nothing will allay. Either vomiting or delirium was 
to be dreaded, and it is difficult to decide which is the most unfavour- 
able ; when the latter was accompanied by fever, it was generally a less 
fatal symptom. 

" The paroxysms generally ran into each other, and the disease 
assumed the form of continued fever, the symptoms all becoming 
aggravated. In this stage delirium, or coma, generally set in, and the 
delirium frequently became so furious, that it was found necessary to 
confine the patient in bed. The skin in such cases was dry and hot ; 
pulse small and very quick ; tongue hard, dry and brown, or covered 
with a black tenacious crust, occasionally red, resembling beef-steak." 

"When the stomach \vas affected, which occurred in the greater 
number of cases, vomiting became excessive, and everything was imme- 
diately rejected, whether in the shape of nutriment, or medicine ; the 
skin assumes a dark brownish hue, afterwards changes to a livid or blue 
colour. These fatal cases have taken place every day, from the third and 
fourth, to the eighth and fourteenth day, but most commonly occurred 
between the fifth and eighth day." 

The 50tli Regiment at Spanish Town, six years in the island, 
which had suffered from the black vomit variety, a few months 
after their arrival in 1819, at this time laboured under a some- 
what similar fever to that in the 33rd, and in a strength of five 
companies, had 378 cases, and 80 deaths, which generally occurred 
from the fifth to the eighth day. 

The period of residence of these several regiments, implying 
a different constitutional susceptibility, and disease of organs, 
consequent upon residence and former fevers, will, I think, 
sufficiently explain the modification in their respective diseases, 
without supposing a separate and distinct cause. For none, but 
those who contend for this, knowing the almost uniform eruption 
of black vomit fever, among newly arrived regiments in Jamaica, 
Yi^ill doubt that had the 77th been placed in either of the stations 
of the 33rd and 50th this year, the same description of fever 
would have assailed them as that from which they suffered at 
Stoney Hill. In the one we have the dissolved blood pouring 
itself out in hsemorrhages and black vomit, leading, as has been 
suggested to paleness of the liver, and an apparently normal 
condition of the spleen ; in the other, we find both these organs 
dark, engorged, and enlarged, with '^the portal vessels distended 
with dark fluid blood," differences, taken with the symptoms 
during life, which the pathologist will be able to interpret and 
reconcile as very intelligible modifications of the same disease. 
In the one we have a more dissolved state of the blood, or a less 



appears in the acclimated. 



393 



arrest of it in diseased organs, giving rise to hsemorrhage " from 
every orifice ;" in the other, we find the circulation struggling to 
the same termination, but, as in the malignant remittent generally, 
more determined to the brain ; which in the Bulam is sometimes 
very little disturbed, the stomach appearing to be generally the 
centre of the mischief. The predominant affection of the one or 
the other of these organs, not only occasions marked diff'erences 
in the fevers of the West Indies ; but constitutes, according as 
it may prevail, the great leading difference in« all intertropical 
fevers, which will be found to approach to, or recede from, the 
character common to the country in which they occur, in corres- 
pondence with this more than from, in my opinion, any essential 
difference in their nature. 

We have here, in the fever of the 77th regiment, an alleged 
specific, defined and contagious disease, varying from excitement 
to great nervous disturbance, from the remittent to the continued 
type, from symptoms differing little from those of the endemic 
remittent, to the most concentrated form, and that apparently by 
increasing heat and changes of weather, which may modify, but 
can never, as here, so change the character and arrest the pro- 
gress of a distinct and contagious disease. The advocates for 
the distinct nature of the Bulam, may contend there were here 
two diseases ; but the transition from the one to the other, was 
too gradual; the susceptibility of subject, and other conditions 
too much on a par, and the influence of atmospheric causes 
too palpable to give any support to such a notion. But this is 
only one of the many instances of the remittent becoming exalted 
to the Bulam ; for though the latter frequently bursts forth at 
once in its utmost malignancy, there are other occasions in 
which it seems gradually to rise from a very moderate continued, 
or remittent fever, to one of great intensity. Cases of the ordi- 
nary fevers are now, and again observed in the most malignant 
epidemics of the Bulam. In the year 1827, when the 22nd regi- 
ment, at Stoney Hill, in Jamaica, lost 122 men and 7 officers, in 
about two months, by black vomit fever, which attacked them 
about eight months after arrival; "the fever," says Surgeon 
Owen, "was sometimes prolonged to 10 or 12 days, but consi- 
derable remissions took place in these cases ; relapses were very 
frequent, and generally fatal." I notice these cases as from 
their occurrence in black vomit endemics, with fresh subjects, 
they are less open to question ; but the fact of the frequent re- 
mittent character of the Bulam, in many instances, is too gene- 
rally confirmed by medical officers, who have seen the disease 
in the more humid islands, to leave any doubt of its more than 
accidental connection with the ordinary fevers, and their causes. 

I believe the cause of the aggravation and increase of the 
ordinary fevers, and their assumption of the Bulam form, to be 
always an epidemic constitution of atmosphere in the Mediter- 

2 D 



394 



Indefinite Character of the Bulam 



ranean, and tlie northern States of America, assisted by malaria, 
in its extended sense ; and that these equally obtain in the West 
Indies, and all other places, as far as relates to the native, and 
other acclimated residents ; deviations from this depending for 
the most part, not on the arrival of ships, as is alleged by the 
ultra- contagionist, but on a more intelhgible contingency, the 
presence of the unassimilated European, under some excess, to 
him at least, in the ordinary causes of disease. 

I believe marsh miasma not to be an indispensible element in 
the production of Yellow Fever, which would appear to origi- 
nate from some increase in the ordinary febrific causes of what- 
ever kind, and to obey the influence of climate, constitution, and 
the other conditions under which it may happen, rather than the 
action of any single, uniform, or specific cause ; in other words, 
that continued, remittent, and sometimes intermittent fevers may- 
become exalted to the Yellow Fever, and derive their resemblance 
to each other, not from any peculiar exciting cause, but from the 
tendency of all intense febrile action, to take on the characteristic 
affection of organs common to the fevers of the latitudes in which 
they occur. 

I believe the Bulam to have no specific character, or pathogno- 
monic symptom, not to be defined in its course, duration, or 
other attributes ; but an occasional variety of a numerous and 
protean class of fevers, continued, remittent, and intermittent of 
certain latitudes; and to difi'er from these only in violence, 
rapidity of course, and ultimate phenomena ; its apparent causes, 
its leading and essential symptoms, and pathological conditions, 
with the periods of its rise, acme, and decline, declaring it to be 
like them, a variety of the same genus, which, I am convinced 
however practically useful, cannot with any pathological correct- 
ness, or hope of reconciling the conflicting facts in the history of 
tropical fevers, admit of sub-division on any discoverable essen- 
tial difference in its multiform species. 

It may be thought 1 have generalized too much ; I have 
endeavoured to avoir! it, but the facts will fully bear me out. I 
cannot regard the Bulam as a distinct disease ; for though it 
differs in some points from the ordinary fevers, its close approxi- 
mation in some of the leading and more essential symptoms and 
morbid lesions, with the strong collateral evidence in favour of 
its identity with, these in nature and in cause, force me to the 
conclusion that they cannot be disjoined as fundamentally dif- 
ferent diseases. It is true we often see the Bulam so isolated 
and apparently so unconnected with the ordinary fevers, as to 
give to it the appearance of a distinct disease ; but on the other 
hand, how frequently is its outset, progress, and decline, marked 
by cases of these, so nearly approximating to it, as to defy any 
attempt to say where the one ends and the other begins, or on 
any just grounds to point to a difl'erent cause. These and other 



Fever, in the Stranger, on High Lands. 



395 



considerations strongly impress me with the conviction, that the 
Bulam^ like occasional deviations in other fevers, must take its 
place as a grade. As such we can find its parallel in other 
climates, which we cannot do if we consider it a distinct disease, 
and this circumstance alone should make us pause in attempting 
it. For it looks more like the creation of imagination, than of 
nature, that a disease sui generis/' should only be known in 
certain latitudes, in certain seasons, and often in certain classes. 

It seems to me that the mortality and peculiar termination of 
the Bulam have ''frighted us from our propriety," and the 
exercise of our general experience ; that we have not taken as 
our guide the fully formed disease, amounting as it frequently 
does, to little more, (making allowance for difference of climate), 
than a simple continued or remittent fever in this country, but 
have fixed our attention on its epidemic and most malignant 
form, which is the result of occasional and adventitious circum- 
stances of aggravation, not of any morbid action, like that of the 
exanthemata, to run a defined and determinate course ; the most 
trifling differences of locality, and of weather, often entirely 
changing the general aspect of the disease, its rate of mortality, 
and the phenomena from which it has been thought to derive a 
distinctive character. In 1843, I was in charge of a regiment at 
Maroon Town, Jamaica, 2,500 feet above the sea level. They 
arrived from the Mediterranean in March, and in June numerous 
cases of fever of a continued type occurred among men, officers, 
and others. From its outbreak in June to November, 80 cases 
among the men were admitted into hospital, and the symptoms 
are described in my report of the period, as follows : — 

"At the outset rigors, nausea, and vomiting, with confusion of thought 
or oppression of head and general malaise, amounting, in several cases, 
to considerable general distress, anxiety, and apprehension. These 
were soon followed by headache, sometimes very severe; white tongue, 
thirst, high and well distributed general heat and excitement, with 
pains of loins and lower extremities ; the nausea and vomiting in most 
cases subsiding, in others persisting with some obstinacy. The pulse 
was full, frequent, and generally soft and compressible ; skin hot, but 
seldom dry, the bowels bound, great and distressing wakefulness. 
These symptoms were usually on the decline about the third or fourth 
day, and convalesence was not infrequent from the fifth to sixth day, 
leaving, however, in several cases, a very protracted and sometimes 
obstinate debility, and nervous exhaustion. All, however, eventually 
and perfectly recovered." 

This then was, what has been not inaptly termed the season- 
ing fever" of the 77th regiment in the mountains in 1843, as 
was the Bulam in the same regiment in the lowlands in 1825, 
as previously described, and which a few miles in the direction 
of the lowlands, would, I have no doubt, have converted into all 
the intensity characteristic of the Bulam. Will any one, but the 
advocates for the Bulam being a distinct disease, believe there 

2 D 2 



396 



Question of Immunity from 



was any essential difference in these two fevers, or doubt that a 
change to a temperature of 10 degrees higher, and other causes 
of aggravation to be found in the lowlands, would have exalted 
the same fever, in the same subjects into a much more formid- 
able and fatal disease, and that too with black vomit, which is 
neither pathognomonic, nor essential to the disease, but a cha- 
racteristic termination of intense febrile action in the unaccli- 
mated in certain latitudes. 

Much of the controversy in Yellow Fever, has been on the 
type of the disease, some contending for its remittent, others 
for its purely continued form. Facts in my opinion the 
most convincing, prove that either may be aggravated by cir- 
cumstances of locality, season, and subject, so as to take on in 
fatal cases, the ultimate phenomena of the Bulani variety. Hence 
in some localities we find the Bulam and its associated fevers 
purely continued ; in others as purely remittent, as distinct 
remissions in protracted cases and the concomitant fevers can de- 
monstrate. The contagionists attempt to explain this by sup- 
posing a mixed or compUcated disease ; but competent and trust- 
worthy observers will bear me out in saying, that the remittent 
form is often as much a part and essential to the Bulam, as the 
continued type, and that this supposed distinct disease is but an 
occasional and exalted variety of all types of fever. The black 
vomit fever of the swamps of Minorca, as described by Cleghorn, 
is as well entitled to the name of the Bulam, as the continued 
fever of Barbados, the violence of disease and common termina- 
tion obscuring all distinction. 

If I have interpreted and applied the facts correctly, the Bulam 
variety may be the occasional offspring of the continued, remittent, 
or intermittent fever, is part and parcel of one or other of these, 
and has no separate or independent existence. Sir William 
Pym says there were two distinct diseases on board the "Eclair," 
at two different periods, the remittent and the Bulam ; I think 
it very probable there were two varieties of one genus, the 
remittent and continued, but I must believe that the black vomit 
cases, under the first, were as much the genuine Bulam as those 
in the second ; exalted febrile action in both, leading to one and 
the same train of ultimate phenomena. The contagionists may 
select what type they please, but as the essential symptoms which 
must be taken from curable, as well as from fatal cases, amount to 
nothing very determinate, it is difiicult to believe that either 
should be capable of reproducing itself 

Does the yellow or Bulam fever, like small-pox, give an immu- 
nity from second attacks, except in very rare instances ? 

I believe the Bulam fever, like length of residence, to give a 
considerable degree of security against an attack in the same 
form, or that form which terminates in black vomit, but little 



Second Attacks in Yellow Fever. 



397 



protection against what I consider other forms of the disease, or 
those which attack the acclimated, and which I beUeve to origi- 
nate from the same causes. The apparent immunity, therefore, 
from a second attack is not real, the same fever is liable to recur 
in a different form, or that of the remittent, modified by assimi- 
lation to the climate, and the disease of organs, which, with the 
soldier at least, would seem to follow a lengthened residence in 
the West Indies, and to determine important differences in the 
phases and phenomena of the fevers which attack him subse- 
quent to the Bulam, or after assimilation to the climate. 

As I said before, I cannot believe there is one cause of fever 
for the acclimated, and another for the new comer, or that causes 
equal to the production of the Bulam, which amounts in some 
cases to a very moderate fever, should be inactive and uncon- 
cerned in the subsequent fevers inseparable fro^i long residence. 

The history of fever^ with regiments in Jamaica, from 1816 
to 1838, has been nearly uniformly marked, first, by a wide 
spread and destructive black vomit fever, generally within 12 
months of their arrival, and following this at a longer or shorter 
interval, and sometimes on the same station, the remittent form 
in greater or less severity and frequency, and often with a mor- 
tality equal to, and sometimes exceeding that of the Bulam. 
Now can it be imagined that causes equal to the production of 
destructive remittent fever, approaching in all the leading fea- 
tures, those of the Bulam, should not have been engaged in the 
invasion of the latter ? Nothing in my opinion, can save us 
from the inevitable conclusion, that these fevers were different 
forms of the same disease, modified by differences in constitu- 
tional susceptibility, unless we believe with the ultra-conta- 
gionists, that the cause of the first was contagion, and wholly 
unconnected with that of the other, an admission which few 
would concede. 

Black vomit fever seldom occurs twice in the same regiment, 
where there has been time for acclimatization ; where it does, the 
ultra- contagionists by an " a posteriori" ingenuity contend that 
those who recovered in the first invasion could not have had the 
Bulam, but the remittent ; and it is difficult to controvert this ; 
for the black vomit being almost always fatal, is not likely to 
occur twice in the same person ; but as relapses are as frequent, 
if not more so in the bulam as in any other fever, the non-recur- 
rence of the disease, which they seek to establish, cannot. I think, 
be granted. Dr. Gillkrest states, there were 102 relapses in the 
fevers of the five regiments in Gibraltar, in 1828, several of 
them, after being considered convalescent, and out of bed. The 
oral and written testimony of medical officers, generally, confirms 
the frequent occurrence of relapses in Yellow Fever. 

I concede the fact of the general non-recurrence of the Bulam, 
qualified by the reasons above stated, viz., that it is the fever of 



Difficulty of proof. 



the new comer, — longer residence preparing the constitution for 
the disease in another form, the endemic remittent, — but the 
principle of its non-recurrence, contended for by the ultra- con- 
tagionists, I cannot grant, and consider that this is contradicted 
by the whole history of fever, as it attacks the troops in the 
West Indies. In the statistical reports on the health of the 
troops in the West Indies, ample evidence has been adduced 
to prove that the liability to fever and mortality, increases with 
length of residence; and Dr. Jackson has shown that in the 
period of 12 years, viz., from 1803 to 1814, the mortality among 
the troops in the Windward and Leeward Islands amounted to 
15,606 ; the greater proportion from fever, and that too from ende- 
mic causes, which I cannot doubt were similar to those productive 
of the Bulam ; diversified in their eflfects by constitutional 
diiferences, intelligible to all, except those who would elevate 
the Bulam into a genus, which I am convinced it cannot claim. 

Simple length of residence in climates where the Yellow Fever, 
has never it is said, appeared, affords to a certain extent, the 
same inaptitude to the Bulam (form,) as the disease itself; a cir- 
cumstance corroborative of the immunity being derived from assi- 
milation to the climate, rather than from the disease. " Eight 
officers," says Sir W. Pym in his notice of the epidemic in 1804, 
in Gibraltar (who had been in India), belonging to this regi- 
ment, (10th), were attacked with the fever, and all recovered. 
Seven officers who had not been in India had the disease in so 
diffisrent a form, that five of them died ; 400 of the men, who 
had been in India, were attacked with the disease, of which" 
number only four died, and of 48 who had not been in India, 
16 died/' p. 25. 

It is pretty certain, that the fact of a person having gone 
through the Bulam, frequently rests entirely upon the circum- 
stance of its occurrence in conjunction with black vomit cases 
in an epidemic season ; for, in those who recover, some are so * 
slightly affected as not to present a single symptom, or group of 
symptoms, which can be considered peculiar to, or diagnostic 
of, any particular fever, and if occurring at any other time, 
would be designated as ordinary continued, or remittent fever. 
It is evident, therefore, that the contagionist in claiming the 
protective power for the Bulam, proceeds, to a great extent, on 
the assumption that the cause, as well as the fever, is occasional 
and contagious, and that all cases of a sporadic kind simulating 
the milder cases of the Bulam, in which he cannot find his 
diagnostic the black vomit, cannot, by any possibility, be the 
same fever. But let us assume that the cause of Bulam is 
neither foreign nor contagious, but endemic, which we have 
good grounds for doing, can we believe that this cause only 
exists in a degree equal to the production of the Bulam, and 
can give rise to no lower grade of fever ? If we admit, which 



Question of Contagion. 



3a9 



we must do, that the natives labour under mild forms of fever, 
and that the inhabitants of Gibraltar and Spain are not entirely 
exempt from febrile attacks, although they may have gone 
through an epidemic — what grounds have we for believing 
that these mild attacks arise from a different cause to that pro- 
ducing more formidable effects in the unacclimated ? and if we 
do not consider it different, but the same, which there is every 
reason to conclude, the contagionists are obviously ascribing to 
a principle in the disease, that which is attributable to assimila- 
tion to the climate, or, in other words, to an acquired resistance 
to the violent operation of the cause, and not to the complete 
exemption from a recurrence of the disease. 

" In mild cases, however, of this last disease (Bulam)," says 
Sir William Pym, and of which there are many, it is impossible 
to point out any symptoms distinguishing it from attacks of 
fever from any cause, and even in bad cases, until the fatal 
symptoms make their appearance, I may say (exceptiDg its 
prevailing epidemically) it is as difficult to decide upon its 
real nature, as it is in the fever of small pox before the appear- 
ance of the eruption," page 4. If, therefore, mild fevers occur 
among the acclimated in the West Indies and Spain in non- 
epidemic years, it is impossible for the contagionist to determine 
what are, and what are not, second attacks, and he evidently as- 
sumes the latter on no better grounds than the absence of black 
vomit, or, in other words, that the Bulam must be marked in 
some cases by that termination to determine its presence ; an 
assumption which the advocates of local causes and non-con- 
tasfion cannot admit. 

Is the Yellow or Bulam Fever contagious ? 

I believe Yellow Fever in its simple form to be absolutely 
and universally non-contagious. 

I know of no disease entitled to be considered contagious, so 
dependent on consitutional, atmospheric, and local causes, as 
Yellow Fever is notoriously known to be ; confined to certain 
parallels of latitude, to certain seasons, and often to certain 
classes, it wants that universality marking the class of specific 
contagions ; and looking to its intimate alliance with the fevers of 
malaria, and the high temperature under which it commonly 
occurs, together with the absence of what I consider proof, I 
do not believe that Yellow Fever in its simple form can, by 
any contingency, reproduce itself. 

In the outbreaks of the disease in the Mediterranean, " all 
other diseases have seemed to merge in the reigning epidemic," 
an implied exclusion of ordinary causes more consistent with 
some general and atmospherical change than any suspension of 
these which a strictly contagious disease, more especially an 
imported one, was likely to occasion. There is no greater proof 



400 



Rapid extension of the Disease. 



to my mind of the non-contagious nature of a disease than its 
indiscriminate spread through a large population within a few 
months ; and when we look to 76,000 persons attacked out of 
80,000 in Seville in 1800 ; to 48,000 out of a population of 
60,000 in Cadiz in the same year ; with other destructive 
eruptions of the disease in Spain, where, in 1804, no less than 
23 cities were afflicted, and these nearly always in the last five 
months of the year ; it seems more consistent with our expe- 
rience to believe, that some general, or epidemic cause, was at 
work, than that, in so short a space of time, such multitudes, 
with all their fears and consequent precautions, should have 
come within the limited sphere of contagion, which, according 
to Haygarth, will not reach beyond half a yard in the open air, 
even in the malignant small-pox. 

The spread of a disease to great numbers can rarely be held 
as any proof of contagion, but rather the reverse, and I may 
safely affirm, that the acknowledged contagious ; diseases have 
never, in a given time, proved so universal and destructive as 
many of the epidemics of Yellow Fever. 

There are no better grounds for suspecting contagion in 
Yellow Fever, on account of its rapid diffusion among a popu- 
lation, than for the fever of the British army at Walcheren, 
where McLean says, " On the 17th September 8,200 or more 
than one-half were sick, on the 22nd 9,500, and on the 23rd 
9.800 or nearly two-thirds, and in one month 1,000 died." 
" The destruction in Hosiers' fleet in 1726 olF the Bastimentos ; 
the loss of 20,000 lives with Vernon at Carthagena; the fate of 
the expedition fitted out from Jamaica for the Spanish main in 
1780; and many similar disasters, are all in proof of the great 
importance of calculating upon the influence of the seasons, and 
the laws of epidemics agents, I may add, which, however 
undefined and incomprehensible, cannot now be questioned, 
except by the ultra- contagionists, with whose doctrine they 
cannot square. The greatest proof of their influence is the 
impossibility of the extension of Yellow Fever beyond its 
appropriate season and weather, at least in Europe. 

Were Yellow Fever a contagious disease, the innumerable 
instances in which the freest intercourse has taken place between 
the diseased and healthy since 1793, would have furnished 
evidence sufficient to satisfy the most prejudiced, and I hold the 
negative proof to the contrary to be so overwhelming and decided, 
as generally to surround the very few suspicious cases opposed 
to it, with every doubt of their being either accurately or candidly 
related. 

Millar, Chervin, Fergusson, and others, state, that attendants 
on the sick have always escaped where the hospitals have been 
placed beyond the noxious atmosphere, and Dr. Gillkrest enu- 
merates 30 towns in America where persons carried disease and 



Exemption of the Negro-race. 



401 



bedding without communicating the disease. • The disease did 
not spread on the Neutral ground at Gibraltar in 1828, though 
the convalescents of the 12th Regiment* took with them their 
clothes and bedding; and according to Chervin and others, 
civilians who carried the disease there, were sick in their tents 
for several days, surrounded by their friends and relations, and 
with entire impunity to the latter. For 18 days that the Tith 
Regiment did not take the town duties, they were entirely 
exempt, and 92 women and 190 children of this regiment, 
several of whose husbands were attacked, escaped the disease; 
a result, says Mr. Amiel, scarcely attributable in those cases to 
the free air of the neutral ground, v/hich is supposed to have 
great power of dilution by the contagionists, though much in- 
ferior in strength and constancy to the " breezes " of the West 
Indies in which the disease is known to rage with the greatest 
malignancy. 

In nearly all the epidemics of late years among the troops in 
the West Indies, a removal to camp has been almost always 
successful in immediately arresting the disease, and so effectual 
is this known to be, that the measure is now very properly not 
left at the mercy of any opinion, but peremptorily required to 
be always carried into effect. 

The exemption of the black races, and, to a great extent of 
the coloured population of hot countries, which can only be 
attributed to their assimilation to heat and the other local causes 
of Yellow Fever, the blacks in the Northern States of America 
suffering equally with the whites, I consider one of the strongest 
proofs of the domestic origin of the disease, and of its non-con- 
tagious nature. Mr. Doughty states, "that blacks and people 
of colour have, in the West Indies, seemed to have been as free 
from the fever as the person who has had the small-pox, is 
against its recurrence. The pioneers, who removed the most 
obnoxious matters from the sick, were never affected." 

" During the autumnal months/' says Dr. Lewis, of Mobile, 
" congestive fever prevailed so generally in my neighbourhood 
as to amount to an epidemic ; there were, in my professional 
circle, two blacks to one white, yet I did not see a single case of 
congestive fever in a negro, nor did I hear that any died of the 
disease in that country. I have made inquiries of several 
medical gentlemen who have been long practising in the 
country, their experience does not materially differ from mine ; 
the fact is, that the remarkable exemption from Yellow Fever 
which this race enjoys, extends, in a great measure, to all the 
malarious fevers of hot countries." f A remarkable instance of 
the latter is to be found in the exemption of the negroes in'the 



* There is probably some slight error in transcribing here ; but the details may be 
referred to in Mr. Amiel's " Replies to Queries." p. 6. [G. B. H.] 
t Bartlett on Fever. 



402 



Comparative Immunity of Females. 



expedition to the Niger. Staff Surgeon La^Yson mentions, that 
though the black population in Free Town, Sierra Leone, in 
1837, amounted to 14,000, and the European to 80; there were 
more cases among the latter, than the former of whom only 
three died. Even length of residence would appear to give 
exemption, for it will scarcely be contended that, the 3,000 or 
4,000 Frenchmen who fled to Philadelphia, as stated by Dr. 
Bancroft at the time of the epidemic there in 1 793, owed their 
entire exemption to former attacks, unless it be admitted that 
the disease is much more constantly present, and in a more 
mitigated form, than allowed by the contagionists. 

So discriminative a property as here evinced, a property so 
constant, uniform, and to be calculated upon, is at variance with 
all our notions of a readily transmissible disease. " Places not 
persons," says Dr. Fergusson ; for though black vomit cases are 
from time to time carried to the mountains of Jamaica, and put 
into the same hospital with other patients, no instance of its ever 
taving been communicated is known, and the same will apply to 
less distant and elevated places, which, were the disease con- 
tagious, would have furnished the strongest evidence of its 
powers. 

No less opposed to contagion is the comparative immunity of 
females, " the ministering angel" in all our sickness, and there- 
fore necessarily more exposed to diseases of a contagious nature. 
In the epidemic of Cadiz in 1800 the mortality was 7,387, of 
which 5,810 were males and 1,577 females. Lygon mentions, 
that in the epidemic of Barbadoes in 1647, " for one woman that 
died there were 10 men." In the epidemic of 1804 in Spain, 
the aggregate mortality in 23 towns was 45,822, of which 
28,352 were males, and J 7,470 females. But it is unnecessary 
to multiply instances; the preponderance is almost constant, 
and the inference to be drawn is too conclusive, in my opinion, 
for any sophistry to set aside.* 

There can be no proof so satisfactory of contagion, as carrying 
the disease from the place of infection, and transmitting it to the 
healthy at a distance. It is here the contagionists have failed, 
for though thousands have, from time to time, died of the 
disease at short distances from infected localities, and among the 
healthy, the few cases they have collected, and that with much 
difficulty, serve rather to amuse than convince, and cannot, in 
my opinion, stand opposed to the facts, demonstrative of the 
incapability of Yellow Fever sustaining the character of a viru- 
lent and consistent contagion. 

In the year 1800, says Chervin, 14,000 persons left Cadiz on 
the breaking out of Yellow Fever; in Alicant in 1804, 2,110 
lied; in Tortosa in 1821, 5,000; in Majorca in 1821.20,000; 
in Barcelona, in the same year, 80,000 persons, several of them 



* A similar preponderance is observed in periodical fevers. 



Uvideuce of Br. Gillkrest. 403 

e 

sick, migrated ; and in the epidemic of Leghorn 8,000 or 
J 0,000 persons fled to Pisa and the adjacent country, without 
spreading the disease. 

"In the epidemic of New York in 1805/' Dr. MiUar says, 
*' there was no communication of the disease in hospitals, at a 
small distance from the city. The hospital attendants and 
those occupied in the removal of the sick from the city to 
the hospital, and who went into the most pestilential quarters 
of the town, entered filthy apartments, and lifted the sick into 
their carriages, dressed in their foulest clothes, and sinking 
under the worst degrees of disease," escaped. 

In the late epidemic in Barbados in 1847-8, while the 66th 
and artillery were more or less attacked with black vomit fever 
from February to December 1848, the 72nd in the same gar- 
rison, equally susceptible with the 66th, a short distance from 
them, and with the most unrestricted intercourse, remained free 
from the disease till October. 

" In the month of March 1825," says Dr. Venables, of the 
Ordnance, " a detachment consisting of two Companies arrived 
from England ; they were composed almost entirely of very 
young soldiers, who had never before served on any foreign 
station. One Company landed at Port Royal where it remained, 
the other was ordered to proceed to Up Park Camp. The 
Company stationed at Port Poyal lost 12 men by fever in less 
than three months, viz., from '22nd March to lOth June, the 
other troops at the same time in the same garrison (three Com- 
panies, 50th Regiment, 153 strong,) lost not one man by fever,, 
or any other disease during the same period, and yet the most 
free and unrestricted intercourse prevailed amongst all the 
ti'oops in garrison at the time." Among the detachment of the 
50th Regiment there were 50 recruits, and, of course^ highly 
susceptible. 

Dr. Gillkrest, in his examination before this Board says — 

" All my experience in the West Indies in 1801, and Gibraltar, in 
1828, and the result of my deepest consideration, as well as a review of 
its history in different parts of the world, go fully to establish the 
strongest conviction on my mind of its not being contagious under any 
circumstances whatever; that even crowding of many patients together, 
though liable to produce other complaints, will not produce Yellow 
Fever any more than ague, which cannot be produced by crowding." 

In support of the above opinion, Dr. Gillkrest submitted the 
following facts : — 

" 1st. That the attacks among 69 fatigue men of the 43rd Regiment, 
who were employed in attending the sick in the epidemic of Gibraltar, 
in 1828, in the number of from 1 to 3 daily, were a fraction less than 
those in the general body of the regiment. 

" 2nd. That although 43 cases had been treated between the 12th and 
28th September, none of the servants had been attacked. The perma- 
nent orderlies were in constant attendance a month before any of them 



404 



Importation of Yellow Fever 



were taken ill in any of the hospitals, and not before the civilians in the 
neighbourhood had become affected. 

" 3rd. That the attacks among the washerwomen could in no case be 
reasonably traced to contagion ; the greater proportion was not at all 
attacked, and those who were, were not attacked until the neighbour- 
hood where they resided had become unhealthy. 

" 4th. That out of 516 individuals of families in the closest contact, 
312* were not attacked ; this being a much larger proportion than in 
contagious diseases, in which some state the non-attacks to be 1 in 26 ; 
others, 1 in 34. 

" 5th. That patients with other diseases, and medical officers, were 
not attacked until the disease had extended to the neighbourhood, until 
an advanced period of the epidemic, and Mr. Frazer, 73rd Regiment, 
who was a considerable time in the lazaretto, was not attacked till he 
came into the garrison, where there was much less chance of contagion. 
I saw three patients in the lazaretto, and Mr. Frazer in attendance 
upon them. 

" 6th. That the military contracted the disease, though in as great 
isolation as it was possible they could be, having for upwards of three 
months, no contact with sick, or with any one who, by the remotest 
possibility, could have transmitted the disease to them. 

"7th. That upwards of 4000 persons removed to the neutral 
ground with their bedding and furniture, and the disease must have 
spread, had it been contagious. 

8th. That a woman of the name of Ackerman was taken ill in a 
shed, and no less than 18 susceptible persons were in contact with her, 
without contracting the disease. 

" 9th. That Mrs. Farquhar, who had had the disease on a former 
• occasion, cut off all communication with persons beyond her gate, on 
account of her niece, who had lately arrived from England. There 
was a space of several yards between the gate and house, so that a close 
approach was prevented. Notwithstanding, this young lady was 
attacked in the severest form and died. 

" 10th. That the vessels in the bay, amounting to 300, were per- 
fectly exempt, though there was constant communication with the 
shore, and one medical gentleman, INIr. Mathias, was in the constant 
practice of visiting his family on board ship, though in daily attend- 
ance upon patients. He died of the disease." 

Is the Yellow or Bulam Fever capahle of being imported ? 

I am of opinion that the Yellow Fever cannot be imported so 
as to extend itself to a previous!)^ iiealthy and unpredisposed 
population ; that the instances of the supposed propagation of 
the disease in this way cannot, in any case I have met with, bear, 
in my opinion, the test of that rigid examination necessary to deter- 
mine a question of such, importance to the interests of humanity 
and science ; and that the coincidences of th.e arrival of dis- 
eased ships, and the eruption of the disease, which will happen as 
long as Yellow Fever exists, and ships sail, cannot be considered 
as cause and effect, but a fortuitous concurrence of events, until 
it shall have been first established that the disease is of a con- 

* Qy. 372. See Appendix I., p. 171. [G B. H.] 



without the Disease being communicated. 



405 



tagious nature, and capable everywhere of showing, under 
favourable circumstances, that character, a conclusion which I 
maintain rests on nothing that can be called evidence. 

Time after time have black vomit cases been landed, at Port 
Royal, Barbados, and other ports, without spreading the disease, 
and that too under the most favourable circumstances for its 
propagation were it contagious ; and however this may be 
attempted to be explained by those who believe in qualified 
contagion, they v*^ill have difficulty in reconciling that a single 
suspected stranger in Gibraltar in 1804; a suspicion in 1810, and 
1813; and the ship "Dygden," with which there had been no 
communication* in 182S ; should on these occasions have proved 
more potent than a ship-load at other times. In 1799/' says 
Tomassini, "the frigate ''General Green,' arrived at New York; 
she had become leaky from the effects of a violent storm, and 
having afterwards been subjected to excessive heat, the Yellow 
Tever broke out. The numbers of sick and of deaths were very 
great. As soon as she arrived, they sent 100 patients on shore ; 
no attention was paid either to the disease, the sick, or their 
effects. Notwithstanding, they did not communicate it to a 
single person, either in the hospital, or in the town !" 

According to Arejula, a fleet from the West Indies, in 1805, 
landed 200 sick at Cadiz, many of them with yellowness of skin, 
and black vomit, and the disease was not communicated to the 
population; and yet the destructive epidemic of 1800 in the 
same place was supposed to have been imported by a ship to 
which no other suspicion could attach than her having been at 
the Havannah. 

Dr. Wilson states that H. IM.'s ship " Euryalus," in 1819, 
anchored in Carlisle Bay^. Barbados, from Bermuda, with fever 
on board ; she was refused pratique, and went to sea. " The 
sickness increased, she put into the Danish Island of St. Thomas, 
where the governor, actuated by the ordinary feelings of huma- 
nity, gave orders for the immediate reception of the sick in 
hospital. Seven men were landed at first, and numbers after- 
wards, and. it was never believed, or alleged, that they commu- 
nicated the disease." 

The principal medical officer in this year was a contagionist, 
the only one, I believe, of an ultra kind, to be found in this class 
for several years, and who had instituted quarantine regulations 
to the great annoyance of the inhabitants. 

" In 1820 and 1821," says Assistant-Surgeon Dr. Bone, 
" Yellow Fever prevailed in St. Ann's Garrison, Barbadoes, 
quarantine regulations were enforced in 1820, but not in 1821, 
and the disease stopped in both years at the same season, the 
beginning of February of the following year." The same writer 
states "that in Tobago, in 18'iO, in 17 months, 99 from 144 



" Qy. no infraction of quarantine regulations. [G. B. H.] 



406 



Influence of Locality. 



persons died in the garrison, although the quarantine regulations 
were enforced.'* " The contagion doctrine," he continues, " was 
strongly opposed by a great majority of the medical department 
in the West Indies, and died a natural death in 182], when 
Inspector Green left the West Indies." 

H. M.'s ship "Pyramus," in 1821, and the " Crocodile," in 
1843, landed several black vomit cases in Barbados, without 
any extension of the disease to the hospital attendants or others. 
In both instances the cause of the disease was satisfactorily 
traced to the foul state of the ships, and several of the persons 
engaged in cleaning them out were attacked. 

There can now be little doubt that the cause of aggravation 
at least, of Yellow Fever, is frequently in the ship herself, and 
the fact of cases coming from the neighbourhood of the pumps, 
and other suspected places as noticed by Dr. Wilson, is corro- 
borative of this. The source of malignancy, if not of the disease, 
appears to be frequently confined to a very limited space. In a 
detachment of troops on Monk's Hill, in Antigua, in 1817, none 
were attacked, except those who did duty at English harbour, 
although they were all treated at the former place. No fever of 
the kind prevailed among the people of the dockyard. 

Lower rooms, married huts, and casemate barracks, have 
always been remarkable for the number and malignancy of cases ; 
and the increase of sick and mortality among the crew of the 
"Eclair" steamer in 1845, by being placed in a small fort at 
Boa Vista, in the month of August, with the thermometer at 86, 
is in perfect keeping with the history of many invasions of the 
disease, in which, as in this case, nothing like contagion could be 
traced for their origin. 

Preliminary to all the deductions of the contagionists is the 
assumption that the disease is contagious, and taking this as 
granted, they have invariably adopted the post hoc propter hoc 
mode of reasoning, and saw proof where others found coincidence, 
a trunk of clothes from the West Indies being with them 
sufficient to infect a whole population, while innumerable 
instances of actual contact with numbers of sick, without the 
transmission of the disease, have been attempted to be explained 
by variation in susceptibility ; the absence of some necessary 
condition, as that of the Ferment oi Hossack, or the predisposition 
and con-cause of Arejula, or to anything but that which rational 
induction would have arrived at, the non-contagious nature of 
the disease. 

The advocates of the transmission of the disease from place to 
place, have assumed as proof of this, the long intervals of 
exemption, but they would require to show that in those inter- 
vals sporadic cases were not observed, and this they cannot do ; 
for the verification of no less than 38 cases that had occurred in 
the few years prior to the epidemic of 1828 in Gibraltar, proves 
the occasional occurrence of a disease identical with what they 



Similarity idtli ordinary Fevers. 



407 



liave alle;^ed to be always imported. The presence of cases of 
Yellow Fever in non-epidemic years in the West Indies may be 
gathered from the following extract of a letter from a private 
practitioner in Jamaica : — 

" Isolated cases of Yellow Fever, of most malignant type, ter- 
minating in black vomit or black dejections, present themselves every 
season in particular localities among new comers. The experience of 
several years of professional connexion with the parishes of St. 
Dorothy, Vere, and the low lands of Clarendon, has afforded me ample 
opportunities of ascertaining this fact." 

I find by the military medical reports, that cases of black 
vomit fever have occurred to a greater or less extent in one or 
more of the Windward and Leeward Islands every year from 
1816 to ] '^47, with the exception of 5 years ; and that Jamaica, 
from 1817 to 1838, when the troops commenced to be quartered 
in the monntainsj was only one year exempt from such cases. 
This tells both ways, either for the almost constant presence of 
local causes for the production of the disease, or that of contagion. 
I leave to disputants to settle the question, I need not say to 
which I subscribe. 

One would suppose that a disease so marked, peculiar, and 
differing " from all other diseases," as the Yellow Fever is said 
to do, would have been immediately recognised on its intro- 
duction in any place were it of foreign origin, but so much has 
it simulated the ordinary fevers in Gibraltar, that in all the 
invasions in that garrison in 1804, 1813, and 1828, we find great 
difference of opinion among medical men at the outset, not only 
as to the identity of the disease, but to any disease different from 
what they had been accustomed to see frequently. In 1828, 
Mr. Dix saw no difference from cases he had observed annually, 
and ISIr. Wilson, of the Civil Hospital, saw nothing unusual in 
the epidemic, except in severity of grade ; he had seen black 
vomit fever almost every year, felt no alarm, and did not report. 
In fact, there are good grounds for believing that the presence of 
the Yellow Fever was determined by all but the importers of 
contagion, by the increase of cases and mortality rather than 
anything peculiar or novel in the nature of the disease. 

If there be any fact well established in Yellow Fever, it is the 
impossibility of transporting it to the free and open country, or 
even to short distances from the scene of its ravages. The non- 
extension of the disease to Brooklyn and other villages adjacent 
to New York, as noticed by Dr. Millar ; to the neutral ground at 
Gibraltar ; or to the encampment of troops ; prove to my mind the 
absence of anything like a contagious principle. The crew of 
the "Eclair," by being placed in the fort at Boa Vista, were 
brought from Scylla to Charybdis, and in no similar case could 
we look for a different result ; but the whole history of the 
disease confirms the fact that, wherever the physical conditions 



408 



Effects of Climate 



are in any respect improved, the mortality is not only diminished, 

but the disease often so changed in aspect as to be repudiated by 
the contagionists, as something totally different to what they 
wish to recognise as genuine Yellow Fever. I would here ask, 
are the admitted specific contagions, under any circumstances, 
so changed as thus to lose the characteristics by which they may 
be identified ? What were the symptoms in the early cases of 
the ships " Bann " and "Eclair," and in the later cases of the 
fever on board the Hussar," which the advocates ol a distinct 
and contagious disease would select as pathognomonic of Yellow 
Fever ? The non-contagionist sees in both cases but modi- 
fications of the same disease. The contagionist, to support his 
doctrine, discovers two distinct and separate diseases, without 
being able to detect a separate and distinct cause. The probable 
aggravation of the fever by the well- prepared constitutions of 
the crew of the " Eclair," and the increasing heat of the weather ; 
very intellig^ible causes of aggravation of fever, are considered 
very subordinate to an assumed contagion, which, under dimi- 
nished temperature on board the " Hussar," cannot sustain the 
same character of disease, but resolves itself into a very moderate 
fever without a death (in about 80 cases) to proclaim its dis- 
tinctive attribute, the black vomit. We have yet to prove that 
the alleged contagion of Yellow Fever differs from all others in 
being increased by heat and diminished by cold." 

It is difficult to say what disease may, by accumulation, acquire 
contagious properties not originally belonging to it, but looking 
to the rapid course of Yellow Fever, the climate, the well- 
ventilated hospitals where it occurs, and its frequent origin in 
causes wholly unconnected with crowding, and the other sup- 
posed sources favourable to infectious diseases, coupled with the 
fact, that contagious diseases in this country, under opposite 
conditions, are generally confined to a very circumscribed area — 
I cannot, in the absence of proof, subscribe to the modern 
opinion of qualified contagion, and must believe, if it has ever 
spread contagiously, that it was no longer genuine Yellow Fever. 
With fever, in my opinion, not essentially different, and a climate 
equally favourable to increase its contagious powers, if such a 
doctrine can be admitted, we have never heard of anything like 
contagious fever in the eastern hemisphere, and as disease is 
pretty equally distributed throughout the world, it creates con- 
siderable suspicion of Yellow Fever being but a grade, and non- 
contagious, that a disease " sui generis " should nowhere find its 
parallel, but in certain latitudes. 

The supposed occasional power of transmission of Yellow 
Fever from person to person rests on no better evidence than 
that which a predetermined search for contagion would find in 
influenza and other non-contagious diseases. The only pre- 
sumptive proofs, viz., those of communication of the disease to 



in modifying the Disease. 



409 



persons at a distance from tlie infected locality, are so exceedingly 
rare and exceptional, and apparently so incapable under parallel 
circumstances of repetition, as fairly to warrant us in regarding 
them as the semblance of contagion, not the reality. 

The alleged proofs of the contagionists are but as a drop in the 
bucket, compared to the instances in which the disease has failed, 
under equally favourable conditions, to show any apparent con- 
tagion, and were we to admit them, even under all the restric- 
tions of the most qualified advocate of the doctrine, the whole 
history of the disease attests the fact, that no past experience 
would enable us to draw the line, or to predict the time, place, 
or other circumstances, under which it might develope this pro- 
perty ; the alleged virulent contagion of one epidemic, not only 
failing to show itself in another > but so absolutely disproved by 
the occurrences, where " cseteris paribus" it might be again looked 
for, as to involve contradictions which no one but an ultra-con- 
tagionist can hope to reconcile. 

The varied character of the disease, its restriction to certain 
boundaries, the modification it undergoes by changes of weather 
and locality, its selection of certain subjects, on the presence of 
whom, in the West Indies, even its very existence depends, 
must exclude it from the class of specific and perpetuated conta- 
gions ; and who by any facts he can bring forward, will presume 
to determine at what period a fever of a remittent type, and 
wanting for a time in several of the more marked symptoms of 
the Bulam, as in that of the 77th regiment, at Stoney Hill, 
acquires contagious properties. Is the operation of contagion so 
little determinate, so contingent and variable in degree, as not 
only to show itself under different forms and grades of disease, 
but to be abruptly extinguished by rain, and renewed by dry 
weather, a? on this and several other occasions ? Is contagion so 
discriminative, that it should pick out, as if from the muster 
roll, as Dr. Fergusson says, certain unacclimated men in a regi- 
ment, leaving the older residents who may, or may not, have had 
fever, either exempt, or with symptoms which according to the 
contagionists, cannot by any possibility have the same origin, 
though occurring at the same time, in the same barrack-room, 
and under the same mode of living, discipline, and exposure ? 

In an epidemic, simultaneously involving great numbers, and 
that at distant points, can the attack of the healthy, after inter- 
course with the diseased, be fairly considered as cause and eifect ? 
Can the successive attacks of several members of the same family, 
of conductors of sick, and of patients under other diseases, or 
their attendants, be ascribed to contagion, in a community 
equally predisposed, and within the sphere of the same local 
causes ? for local and circumscribed they are proved to be as the 
almost invariable arrest of the disease by a removal to a very 
short distance incontestibly demonstrates. Are not the same 

2 E 



410 



Arrival of Ships. 



occurrences, the same order of sequence to be found, in a wide 
spread remittent fever, or other non-contagious disease, and are 
we in the face of the strongest collateral evidence of the non- 
contagious nature of the Bulam, to regard these as proofs ? for 
beyond this, beyond the immediate scene and place of its eruption 
and ravages, the contagionist cannot carry his proofs, and is 
constantly reminded of the evanescent nature of his contagion, 
which, though he imagines can be transported across the Atlantic, 
fails to afford him the slightest support, a few yards from where 
it has destroj^-ed hundreds, — the sick, the dying, their clothes, 
bedding, and other effects, being then insufficient to originate a 
single case of a disease, which at other times has been supposed 
to extend itself to the whole of the West Indies from a bag of 
foul linen. 

To return to the question of importation, can we be more than 
amused, when we are gravely expected to believe that the dis- 
ease was introduced into Gibraltar, in 1804, by a single stranger, 
and in 1814 and 1828, by something much less tangible, a sus- 
picion which in the latter year, with the most assidious search 
of those " who wished to prove importation," remained totally 
unsupported ? I ask, can we, knowing the occurrence of sporadic 
cases, from time to time, without the extension of the disease, its 
frequent spontaneous outbreaks, and epidemic prevalence in 
other places where no such suspicion existed, and where there 
were abundance of other circumstances to which all experience 
points as intelligible causes, give any credit to such statements ? 

Is it the coincidence of the arrival of ships from suspected 
places, and the breaking out of the disease that can strengthen 
our belief in importation, when it is known that between 1816 
and 1828, 840 vessels arrived in this bay (Gibraltar) from the 
Transatlantic countries, where the Yellow Fever usually pre- 
vails ; and that black vomit cases have been landed again and 
again in other ports with an impunity which, were the disease 
contagious, no variation in predisposition, or the alleged pro- 
tection of former attacks, the constant refuge of contagionists, 
could reconcile ? ''In 1802," says M. Chervin, quoting from 
Pariset, " Admiral Gravina caused 500 patients with Yellow 
Fever to be disembarked at Cadiz, who were taken to the Hos- 
pital St. Juan de Dios, and treated therein, without having com- 
municated their malady to any person.'' 

Is it the interval between one epidemic and another, or the 
previously healthy condition of a population, which can warrant 
the conclusion, when the same equally apply to visitations of 
influenza, and other non-contagious diseases throughout the 
world. ? 

Is it the eruption of a new and peculiar disease unknown to 
the place, the season, or any other circumstance attending its 
evasion, that justify belief in importation, when we know that 



Case of the " Eclair'' 



411 



sporadic cases are familiar to the resident medical men, and 
occur almost always at a season weji known, throughout the 
Mediterranean, as the most prolific of fever in its epidemic 
form ? 

Is it the locale of its outbreak, and mode of extension, which 
afford grounds for suspecting its foreign and contagious nature, 
when it is notorious that whenever the epidemic has appeared 
in Gibraltar, it has always commenced in the " filthiest spot," and 
" that the disease did not spread from any focus, but broke out 
in 50 different places at once V 

Finally is there a single recorded instance of importation that 
can be considered conclusive ? To take the latest and most 
authentic account of its supposed introduction in this way, that 
by the " Eclair " steamer in 1845, into Boa Yista; I submit 
there are circumstances in this history, which, in the present 
state of our knowledge, are calculated to raise every doubt of the 
disease in this island, having been in any way connected with 
the " Eclair." 

Dr. M'William passes over no inconsiderable intercourse with 
the " Eclair," immediately on her arrival ; the exposure of 40 
labourers to the fomites (if any) of the vessel whilst engaged in 
cleaning her out, who returned to their homes every evening ; the 
landing and washing of " about a dozen bags of foul linen," by 
17 washerwomen ; — and fixes the focus of contagion, which it is 
alleged spread to the remote villages, on two soldiers who had 
been from 7 to 11 days respectively, connected with the fort 
before and after the departure of the " Eclair," without contract- 
ing the disease ; and though not themselves attacked for several 
days after intercourse had ceased between them and Anna Gal- 
linha, (" the first case that proved fatal, or attracted any notice 
among the inhabitants,") are yet supposed to have communicated 
the disease to this woman, a month after the departure of the 
"Eclair." These men had stripped off the only clothes they 
brought with them from the fort, and " were not laid up " for 
eight days, so that we are left to conclude the disease was com- 
municated in its formative stage, and several days before it had 
developed itself in the persons suspected ; for it does not appear 
to me at all evident according to the general mode of accession* 
of Yellow Fever ^Hhat they had the germs {of the disease) in them, 
by the symptoms alone which were manifest while they were there f 
more particularly in that intense form, accompanied by black 
vomit, which Pedro Manoel, one of these soldiers, stated he 
had had. 

The above circumstances, together with the spread of dis- 
ease among the cattle, as stated by Dr. King, who visited the 
island, and reported upon those occurrences, subsequent to Dr. 



* Vide Dr. Richardson's Report, page 29. 



412 



Report of the French Commission 



M'William ; the unaccountable absence of remittent fever, with 
which a truly contagious and foreign disease was not likely to 
have interfered, the season of the year, and the increase of sick- 
ness and mortality of the people of the " Eclair," in the fort,, 
which was, in every respect^ well calculated to generate Yellow 
Fever, and sicken the guards, without the aid of contagion, — all 
concur to show, in my opinion, an epidemic constitution of atmos- 
phere, and not contagion. Lind notices the liability of the Cape 
de Verd Islands to destructive outbreaks of fever ; and as some 
corroboration of this, I may mention that as medical officer in 
charge of troops and settlers for the Cape on board a transport, 
in 1819, which put into the island of St. Jago for six or eight 
days, I was, as also the master and others, most earnestly en- 
treated and urged by several inhabitants, to hurry our departure, 
on account of the approaching season of fever. 

I may here notice the objection raised by the contagionists 
against the supposed influence of an epidemic cause in Yellow 
Fever, viz., that it would not be confined to the town of Gibraltar, 
but extend to the neutral ground, where the population has 
always found protection. The occurrences in the last visitation 
of cholera in London, may be quoted in reply, and particularly 
the case of the pauper children in Drouet's establishment, at 
Tooting, who were moved to London with the happiest effect, 
thus showing they had simply removed from the conditions 
favourable to the development of the disease. 

As long as men can view things differently, there is ample 
scope for difference of opinion on the subject of Yellow Fever. 
I believe in the present state of our knowledge, the question 
does not admit of being settled ; and the opposite conclusions 
arrived at by the several inquiries, composed as they have been 
of equally competent men, while showing the futility of such 
investigations, points out the propriety of our being satisfied, at 
least for the present, with the instalment which, I conceive, has 
been made towards its adjustment. That instalment, as far as I 
can discover, by a careful analysis and digest of the whole sub- 
ject, supported as it is by the majority of medical officers in the 
army, and I believe in the navy, who have the best opportunities 
of forming correct conclusions, is the great probability of the 
non-contagious nature of the disease. 

In the Report of the Commission appointed in 1827, by the 
Royal Academy of Medicine of Paris, to examine into the docu- 
ments furnished by M. Chervin, relating to Yellow Fever, it 
appears that out of 531 physicians of different countries, 48 only 
admitted the contagion of Yellow Fever, but d degres tres varies 
et avec des restrictions plus ou moins marquees^^ and of these, nine 
were more or less qualified contagionists, some believing it w^as 
not essentially contagious, but might become so under certain 
circumstances ; others that it was contagious in Europe, and the 



appointed by the Academy of Medicine. 



413 



United States, but not in the tropics. On the opinions in favour 
of contagion, the Commission remarks, — 

It is our duty to remark that these documents (42 in number) 
have appeared to us to contain but a very small number of facts, sus- 
ceptible of explanation by contagion, and that they are in general 
wanting in circumstances which would be necessary to deduce from 
them anything conclusive." 

Of the non-contagionists, amounting to 483, the Commission 
states, — 

" That the greater number had witnessed the Yellow Fever during 
periods of from 10, 15, 20, and 30 years, several of them 40 and 50 
years, and that though the American physicians do not unanimously 
recognize non-contagion in Yellow Fever, there is not, perhaps, a dis- 
puted point in medicine, in favour of which it was possible to assemble 
an equally great majority of evidences, than M. Chervin has done on 
the question of which he treats ; and what is truly astonishing, that he 
has obtained these evidences, so like to each other, from physicians of 
so many schools, and of so many different nations. 

But if from opinions, (continues the Commission,) we pass to the 
facts recorded by the non-contagionists, we shall see that they speak 
everywhere, a language clear, positive, and uniform, to which it 
appears to us difficult to withhold confidence. They have never seen 
the Yellow Fever propagate itself in the rural districts in the United 
States, although since 1793, thousands of infected individuals have 
gone to die in the bosom of their families. Contact, the most direct 
and immediate, has not communicated the disease in a single well- 
established case, an assertion which is repeated almost unanimously by 
the physicians of the different towns of the coast, visited by M. Chervin, 
from Louisiana to Maine." 

The Commission conclude their Report by the following 
remarks^ which I prefer to give in the original : — 

" On veut savoir ce qui est reste dans notre esprit de la lecture d'un 
si grand nombre de pieces authentiques dans leur forme, presque toutes, 
dans le sens de la non-contagion. En repondant qu'il en est resulte pour 
nous une impression favorable a ce systeme, nous ne faisons qu'ex- 
primer I'opinion presque unanime de votre Commission. Apres avoir 
pris connaissance de tons les documents qui lui ont ete soumis, apres les 
avoir lus, analyses et discutes un a un, piece a piece, elle pense que ces 
documents, en admettant comme exact les faits qu'ils contiennent, 
meritent I'attention la plus serieuse ; qu'ils augmentent considerable- 
ment la masse des observations favorables a I'opinion de la non-conta- 
gion de la fievre jaune, et qu'ils seraient de nature a concourir puissa- 
ment a etablir en principe cette non-contagion, si, dans I'etat actuel de 
la science cette question pouvait etre resolue." 

These opinions, coming from such men as Dubois, Double, 
Husson, Laubert, Orfila, Kenauldin, Thillaye, and Vauquelin, 
who composed the Commission, are entitled to every confidence ; 
and when we look to the mass of documents from which they 
deduced these opinions, collected as they were, by M. Chervin, 



414 



Opinions of Army Medical Officers. 



in every country, and with a zeal and disinterestedness almost 
unexampled, they contribute in no small d^'ee to the proba- 
bility which I have claimed for non-contagion. No less valuable, 
and tending to the same conclusion, is the collection of facts to 
be found in the reports of army medical officers, extending from 
1816 to 1848. These are plain unvarnished tales," written in 
the midst of, almost at the bedside of. Yellow Fever cases ; 
without bias, and without stimulus, save that of a faithful and 
conscientious discharge of duty, their observations are deserving 
of all the weight and confidence which disinterested inquiry 
may claim. The few, comparatively, who have offered an 
opinion, very generally advocate that of the disease being a grade, 
and non-contagious, but the silence of the majority on these 
questions probably declares more emphatically than volumes, how 
little the bugbear contagion, has haunted their imaginations. 

In conclusion, I am no partisan, I have written this report 
as I have others, simply as an act of duty, and I hope and trust 
in an equally inoffensive spirit. If I have spoken strongly, it 
has been from no disrespect to the opinions of others, for whom 
though opposed to their views, I entertain every deference, but 
from a wish that the facts before me should not fall short of that 
construction and application to which I think them entitled. 
No one who has thoroughly investigated the subject of Yellow 
Fever, but must be deeply impressed with the numerous diffi- 
culties which surround it, and, as equally clear-headed and 
competent men have adopted opposite views concerning it, 
no one, whatever his intellect or pretensions, is warranted in 
arrogating to himself, that he is " Sir Oracle " on a question never 
destined, probably, to be settled by universal assent. I have 
wished to give my opinions, however decidedly I may have ex- 
pressed them, with, I hope, a humility befitting the subject, and 
as I decline all controversy, I deprecate criticism, and trust they 
will be taken for what they are intrinsically worth, and no 
more. 

(Signed) W. H. Bubrell, M.D. 

Staff Su rgeon , \st Class,. 

London, May 29, 1850. 



LONDON: 

Printed by William Clowes and Soxs, Stamford Street, 
For Her Majesty's Stationery Office. 



FtB --0 'j/;2 



GENERAL BOARD OF HEALTI 



SECOND REPORT 



aU AR ANTINE 



YELLOW EEVEK 



WITH APPENDICES. 



'a kill laaais nf ^nrliaiiirEi lii] Cmiiinani af Iti iillnjr' 




LONDON : 
D BY W. CLOWES ft SONS, STAMFORD STRF¥ 

FOB IIEK MAJKSTl 's STATIOMKBY OFFICE. 



